Pharmacy Services Revenue Analyst

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The Financial Analyst of Pharmacy Services Revenue Integrity supports pharmacy services financial performance across the delivery system through financial reporting, data analysis, financial planning, contract proposal evaluations, claims payment accuracy reconciliation, and pharmacy payer contract liaison activities. The Financial Analyst extracts and validates data from various information systems and provides actionable information and recommendations through advanced analytics to assist leaders in managing financial performance.

This is a remote position.

• Analyzing proposals by monitoring payment variances and identifying revenue and cost trends.
• Track contract performance against projections.
• Tracking and updating all third party payer fee schedules, internal charge masters, and payer contracted payment methodologies.
• Reviews charge levels against third party payer contracts, summarizes findings and communicates results to manager and the revenue integrity team.
• Administer revenue capture analysis and report by validating reimbursement and investigating claims.
• Assist manager in third party payer reimbursement appeals.
• Analyze reimbursement for payer appeals opportunities and manage communication with payers.
• Support manager in tracking top contracts, top lines of business and payer mix.
• Ad-hoc reporting to identify third party payor populations as needed by leadership.
• Review reconciliation of claims activity, identifying payment discrepancies and summarize results to manager and Revenue Integrity Operations Team for action.
• Analyze trends to assess efficiency of business activities and recommend plan adjustments or other improvement measures to manager.
• Effectively utilizes multiple systems and applications, such as dispensing systems, spreadsheets, and graphic packages to assemble, manipulate, and/or format data and reports.
• Assist in all revenue integrity operations activities to optimize support and collaboration within the Revenue Integrity team.

• Maintain up-to-date knowledge through attending educational workshops and reviewing publications.
• Develop subject matter expertise for reimbursement and contracting databases such as Inmar.
• Research common third party and health plan claim processing information to ensure accuracy in reporting using payer portal and pharmacy newsletters.
• Participates in meetings and revenue integrity projects with internal and external customers.

• Demonstrates ability to provide care or service adjusting approaches to reflect developmental level and cultural differences of population served.
• Partners with patient care giver in care/decision making.
• Communicates in a respective manner.
• Ensures a safe, secure environment.
• Individualizes plan of care to meet patient needs.
• Modifies clinical interventions based on population served.
• Provides patient education based on assessment of learning needs of patient/care giver.

• Fulfills all organizational requirements
  • Completes all required learning relevant to the role.
  • Complies with and maintains knowledge of all relevant laws, regulation, policies, procedures and standards.
• Fosters a culture of improvement, efficiency and innovative thinking.
• Performs other duties as assigned.

N/A

• Bachelor’s Degree (B.A. or B.S.) in Analytics, Finance, Health Care Administration or Health Care Insurance, Accounting, Business Management.

• 1 - 3 years related experience in financial analysis – preferably with insurance company/payor including both Pharmacy Benefit Manager (PBM) and Health Plan or health care provider system.
• Proficient in Microsoft Suite applications such as Excel, Access, PowerPoint, Word.

• 2 - 4 years experience in health care organization or health insurance company preferred.

• Certified Pharmacy Technician preferred but not required.

Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more! More information: https://(Use the "Apply for this Job" box below)..

The posted pay range is for a 40-hour workweek (1.0 FTE). The actual rate of pay offered within this range may depend on several factors, such as FTE, skills, knowledge, relevant education, experience, and market conditions. Additionally, our organization values pay equity and considers the internal equity of our team when making any offer. Hiring at the maximum of the range is not typical.

If your role is eligible for a sign-on bonus, the bonus program that is approved and in place at the time of offer, is what will be honored.

EEO/Vet/Disabled:
All qualified applicants will receive…