Revenue Cycle Specialist - Pharmacy - Must Reside in Colorado -Hybrid

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Department

Job Summary

The Pharmacy Revenue Cycle Coordinator is responsible for collection and reimbursement activities related to the DHHA pharmacy and DHHA Retail Pharmacy. The person in this position will work to coordinate statement billing activities, account flow to external agencies and facilitate billing and reimbursement knowledge between Hospital and Physicians Business Services (HPBS) and both the Hospital and Retail Pharmacies. This position is responsible for the management of the self-pay account activities located in the retail pharmacy service area. assuring that accounts receive statements are flow to the SBO vendor and ultimately to the bad debt vendor. This position knows the revenue cycle well enough to play a role in pharmacy coding, modifier usage and ultimately code placement on the claim. This position will also understand payer behavior enough to be able to estimate reimbursement for particular drugs, especially 340-B drugs and IV therapy.

The position will report to the director of HPBS but will network with pharmacists, chargemaster and coding personnel, vendor management staff and other HPBS staff. The position is self-directed but will be required to meet targets in the Pharmacy Service Area in the Epic physician (PB) billing system.

Essential Functions:

• Monitor the workflow for self-pay accounts with balances as they go from billed Accounts Receivable (AR) to Bad Debt (BD). Assuring that balances are accurate as they transition in each stage of the workflow. (25%)
• Assure that AR moving from the pharmacy insurance billing system to Epic is reconciled and insurance takebacks are resolved, and the AR is billed to the patient. (15%)
• Understands pharmaceutical reimbursement for the major payers, Medicaid, Medicare, Aetna, Anthem, United Healthcare, and Cigna. And is able to communicate with the pharmacy the expected payment for drugs and biologicals This will include understanding of reimbursement for high-cost drugs used in IV infusion and cancer treatment. (20%)
• Understand and recommend actions required for the correct billing to the major payers, Medicaid, Medicare, Aetna, Anthem, United Healthcare, and Cigna. And is able to communicate with the pharmacy the expected payment for drugs and biologicals This will include understanding of reimbursement for high-cost drugs used in IV infusion and cancer treatment. (20%)
• Resolve any credit balances in Epic (20%)

Education:

• Bachelor's Degree a bachelor's degree in finance, business administration, healthcare administration, nursing, or a related field Required
• Master's Degree Preferred
• A hospital or medical coding certificate preferred

Work Experience:

• 4-6 years billing hospital, medical or physician Required and
• less than 1 year Billing for pharmaceutical claims - preferred
• A 4 year degree in Accounting, Finance, Healthcare or Business Admin may be substituted for revenue cycle experience

Licenses:

• PTCB Education/Training Certificate - PTCB - Pharmacy Technician Certification Board Required

Knowledge, Skills and Abilities:

• A firm understanding of Medical and Hospital coding a coding certificate would be helpful in verification of this skill
• Knows the basic formats of the UB04 and the HCFA 1500, with their various fields and form locators
• Knows the revenue cycle and where most opportunities for improvement happen
• Has a basic understanding of drugs, NDC codes, HCPC and how units are dispensed
• Understands IV medications and the payer processes required to get reimbursement, including coverage, authorization and correct claim formatting.

Shift

Work Type

Salary

Benefits

At Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future - with generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs. We invest in your growth through tuition assistance, career advancement pathways, and professional development - while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions. When you join Denver Health, you're joining a mission-driven organization that invests in you.

Here is a small list of our benefit programs:

• Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays

• 100% paid parental leave up to 6 weeks

• Immediate eligibility for retirement plans with employer contribution up to 9.5%

• Generous medical, dental, vision plans in addition to employer paid disability and life insurance.

• Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center

• Free RTD EcoPass (public transportation)

• Childcare discount programs & exclusive perks on large brands, travel, and more

• Tuition reimbursement & assistance

• Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways

• Professional clinical advancement program & shared governance

• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program

• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

About Denver Health

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, the Public Health Institute at Denver Health, Denver Health Medical Plan and Denver Health Foundation.

As Colorado's primary, and essential, safety-net health care system, Denver Health is a mission-driven organization that has provided millions in uncompensated care for the uninsured each year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community. All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made. Applicants will be considered until the position is filled.