Revenue Integrity Specialist - Specialty Pharmacy

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/Formal Training Requirements

• Required - Bachelor's Degree Health Science
• Preferred - Bachelor's Degree Allied Health
• Preferred - Bachelor's Degree Computer sciences
• Preferred - Bachelor's Degree Healthcare Administration
• Preferred - Bachelor's Degree Information Systems
• Preferred - High School Diploma or Equivalent

Work Experience Requirements

• Required - Pharmacy billing 1-3 years
• Required - Revenue cycle 1-3 years

Licenses and Certifications Requirements

• Required - Pharmacy Technician - Tennessee - Tennessee Board of Pharmacy
• Required - Certified Pharmacy Technician - Pharmacy Technician Certification Board
• Preferred - Pharmacy Technician - Mississippi - Mississippi Board of Pharmacy
• Preferred - Certified Pharmacy Technician- ExCPT - National Healthcareer Association

Knowledge, Skills and Abilities

• Knowledge of third-party payor billing requirements and pharmacy revenue cycle processes.
• Strong leadership, communication, and coaching skills
• Ability to balance independent work with team supervision.
• Excellent attention to detail and organizational skills.
• Proficiency in Microsoft Office (Excel, Word, Outlook).
• Experience with EHR, pharmacy systems, and billing platforms preferred.
• Ability to prioritize, meet deadlines, and adapt in a fast-paced environment.

Supervision Provided by this Position

• May have some lead responsibilities.

Physical Demands

• The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion.
• Must have good balance and coordination.
• The physical requirements of this position are: light work - exerting up to 25 lbs. of force occasionally and/or up to 10 lbs. of force frequently.
• The Associate is required to have close visual acuity to perform an activity, such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; or extensive reading.
• The conditions to which the Associate will be subject in this position: The Associate is not substantially exposed to adverse environmental conditions; job functions are typically performed under conditions such as those found in general office or administrative work.

Our Associates are passionate about what they do, the service they provide and the patients they serve. We value family, team and a Power of One culture that requires commitment to the highest standards of care and unity.

Boasting one of the South's largest medical centers, Memphis blends a friendly community, a thriving and growing downtown, and a low cost of living. We see each day as a new opportunity to make a difference in the lives of the people in our community.