What are the responsibilities and job description for the Pharmacy Revenue & Reimbursement Analyst position at Texas Health?
Pharmacy Revenue & Reimbursement Analyst
Bring your passion to Texas Health so we are Better Together
Work Location: Remote: Texas Health Corporate, 612 E. Lamar Blvd., Arlington, TX 76011
Work Hours: Full Time Days (8:00am-5:00pm) for 40 hrs/week (remote work allowed at manager's discretion)
Department Highlights:
Gain a sense of accomplishment by contributing to a teamwork environment.
- Remote Position
- Remote
What You Will Do:
Revenue Analysis
. Facilitate and support claims processing, rebills, appeals, and follow-up with PBMs and health plans; identify appeal opportunities and manage payor communications to recover underpayments or resolve payment variances.
. Monitor and report aging accounts receivable and key performance metrics (e.g., DSO, applied cash).
. Support 340B revenue optimization activities by monitoring payor and accumulator impacts (where applicable), identifying claim-level variances, and collaborating with pharmacy operations and finance to resolve 340B-related reimbursement issues.
. Develop reports, dashboards, and ad-hoc analysis for payment variances, denials, underpayments, and other trends to support decision-making and process improvements.
. Identify trends related to denials and underpayments; collaborate with appropriate teams to implement improvement initiatives.
45%
Payment Integrity
. Analyze reimbursement from pharmacy claims to validate payment accuracy, ensure compliance with contracted rates, and reconcile claims activity with remittances to ensure payment efficacy.
. Perform 340B payment integrity and audit support activities by analyzing claim-level eligibility/accumulator impacts (as applicable), researching exceptions, and preparing documentation for internal/external reviews.
. Support 340B split billing and vendor processes (as applicable), including data validation, claim qualification troubleshooting, and reconciliation of replenishment/accumulation outputs.
. Support maintenance of third-party payor pharmacy fee schedules, pharmacy charge masters, and contracted pharmacy payment methodologies; evaluate payor contract performance and reimbursement arrangements and support negotiations with data-driven insights.
35%
Revenue Integrity
. Provide education stakeholders to drive optimal revenue capture
. Serve as the system expert on medication-related compliance billing and charging topics
. Develop policies and/or guidelines to improve revenue integrity, charge capture, and billing compliance
. Actively research and stay current with important pharmacy billing and revenue related compliance and optimization topics to guide appropriate organizational decisions
20%
Salary : $1,000 - $1,000,000