Revenue Integrity Specialist - Specialty Pharmacy

Summary

Methodist Le Bonheur Healthcare is a healthcare organization serving the Memphis and Mid-South communities. The Revenue Integrity Specialist - Specialty Pharmacy supports pharmacy revenue cycle operations, including charge capture, claims submission, denial management, payment reconciliation, reporting, process improvement, and staff training. The role may also lead Prior Authorization Specialists and collaborate with pharmacy, finance, and clinical teams to maximize revenue integrity.

Responsibilities

• 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
• 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
• 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
• 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

Skills

• Required - Bachelor's Degree Health Science
• Required - Pharmacy billing 1-3 years
• Required - Revenue cycle 1-3 years
• Required - Pharmacy Technician - Tennessee - Tennessee Board of Pharmacy
• Required - Certified Pharmacy Technician - Pharmacy Technician Certification Board
• 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)
• Ability to prioritize, meet deadlines, and adapt in a fast-paced environment
• 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
• 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
• Preferred - Pharmacy Technician - Mississippi - Mississippi Board of Pharmacy
• Preferred - Certified Pharmacy Technician- ExCPT - National Healthcareer Association
• Experience with EHR, pharmacy systems, and billing platforms preferred

Qualifications

Must Haves

• Required - Bachelor's Degree Health Science
• Required - Pharmacy billing 1-3 years
• Required - Revenue cycle 1-3 years
• Required - Pharmacy Technician - Tennessee - Tennessee Board of Pharmacy
• Required - Certified Pharmacy Technician - Pharmacy Technician Certification Board
• 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)
• Ability to prioritize, meet deadlines, and adapt in a fast-paced environment
• 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

Nice to Haves

• 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
• Preferred - Pharmacy Technician - Mississippi - Mississippi Board of Pharmacy
• Preferred - Certified Pharmacy Technician- ExCPT - National Healthcareer Association
• Experience with EHR, pharmacy systems, and billing platforms preferred

Benefits

• Hybrid work arrangement
• Opportunities for Associates to grow their career