Pharmacy Revenue Cycle Specialist

If you are looking to make an impact on a meaningful scale, come join us as we embrace the Power of One!
 

We strive to be an employer of choice and establish a reputation for being a talent rich organization where Associates can grow their career caring for others. For over a century, we’ve served the health care needs of the people of Memphis and the Mid-South.
 

The Pharmacy Revenue Cycle Specialist position is responsible for supporting all phases of the pharmacy revenue cycle, including charge capture, claims submission, denial management, and financial reconciliation. In addition to performing hands-on revenue cycle duties, this role may act as a lead for the Prior Authorization Specialists, ensuring effective team performance and compliance with billing requirements. The Specialist collaborates with the Pharmacy Revenue Cycle Analyst to identify and address barriers to reimbursement, streamline workflows, and maximize revenue integrity. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

 

Working at MLH means carrying the mission forward of caring for our community and impacting the lives of patients in every way through compassion, a deliberate focus on service expectations and a consistent thriving for excellence.

A Brief Overview
The Pharmacy Revenue Cycle Specialist position is responsible for supporting all phases of the pharmacy revenue cycle, including charge capture, claims submission, denial management, and financial reconciliation. In addition to performing hands-on revenue cycle duties, this role may act as a lead for the Prior Authorization Specialists, ensuring effective team performance and compliance with billing requirements. The Specialist collaborates with the Pharmacy Revenue Cycle Analyst to identify and address barriers to reimbursement, streamline workflows, and maximize revenue integrity. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

What you will do

• Revenue Cycle Operations Review, validate, and reconcile pharmacy charges to submit or resubmit claims to insurance and/or third-party payors. Communicate with the pharmacy team and insurance companies for payment acquisition, pre-authorization, and to resolve patient account inquiries. Monitor patient Accounts Receivable and Guarantor accounts. Appeal and troubleshoot denials within scope; escalate complex cases to the Analyst. Support pre-authorization, billing, and payment reconciliation processes. Aid in the resolution and preparation of audit requests with a focus on system improvement and education for pharmacy operations. Provide the highest customer service experience for patients and providers. Maintain compliance with institutional policies, payor rules, and regulatory standards.
• Data & Reporting Track and log billing denials, claim edits, and resolution outcomes. Assist the Pharmacy Revenue Cycle Analyst with generating routine reports on charge trends, denial rates, and PA metrics. Report discrepancies or compliance concerns promptly to the Analyst. Document revenue cycle activities to meet accrediting agency, payor, and administrative requirements. Process Improvement & Collaboration Identify workflow inefficiencies and recommend improvements to the Analyst. Assist in implementing new billing tools, policies, and technologies. Serve as a liaison between the PA team, pharmacy operations, and finance. Promote a culture of accuracy, accountability, and customer service across the team. Communication/Training Provide training and in-services to others on pharmacy billing procedures and practices. Interfaces closely with pharmacists, Social Work, Financial Counseling, Patient Access/Registration, Nurses, and Physicians. Understand the importance of effective business communication and maintaining professionalism in difficult situations. Participate in the orientation of pharmacy technicians, pharmacists, pharmacy residents, and others within the department on pharmacy billing practices. Participate in the training of pharmacy technicians, pharmacists, pharmacy residents, and others within the department on pharmacy billing practices.

Education Qualifications

• Bachelor's Degree Healthcare Science
• Bachelor's Degree Information Systems
• Bachelor's Degree Computer sciences
• Bachelor's Degree Allied Health

Experience Qualifications

• Minimum of two (2) years of healthcare revenue cycle, pharmacy billing, or prior authorization experience required.
• Substitution: Minimum of six (6) years of healthcare revenue cycle, pharmacy billing, or prior authorization experience in lieu of education requirements

Skills and Abilities

• Knowledge of third-party payor billing requirements and pharmacy revenue cycle processes.