Position Title:

Department:

Job Description:

General Description:

The Pharmacy Revenue Cycle Specialist supports comprehensive pharmacy‑related billing, charge integrity, and reimbursement operations across inpatient, outpatient retail, specialty, and infusion pharmacy services. This role is responsible for identifying, analyzing, and resolving revenue cycle issues to ensure accurate, compliant billing and optimal reimbursement outcomes. The specialist partners with pharmacy, finance, IT, and compliance teams to monitor revenue data, address denials and discrepancies, and support pharmacy revenue operations and audit readiness across the enterprise.

Essential Responsibilities:

Responsibilities listed in this section are core to the position.  Inability to perform these responsibilities, with or without an accommodation, may result in disqualification from the position. 

• Supports pharmacy revenue cycle operations, including billing accuracy, charge integrity, reimbursement reconciliation, and denial resolution across multiple sites of care.

• Manages retail pharmacy follow‑up activities, including cash posting, collections, payment validation, customer correspondence, and reconciliation activities.

• Reconciles daily pharmacy deposits and coordinates bank deposit processing.

• Submits daily receipt audits to accounting, including cash, check, credit card transactions, direct deposits, refunds, and electronic payments.

• Converts pharmacy claim deposits and reconciliations to electronic processing, including auto‑deposit and 835 file utilization, when available.

• Identifies missing reimbursements and works to resolve unreconciled payments, with a focus on reducing outstanding balances over 90 days.

• Collaborates with accounting and finance teams to coordinate deposit timing and investigate reconciliation discrepancies.

• Monitors third‑party reimbursement for underpayments or significant losses and escalates issues to leadership as appropriate.

• Prepares and submits month‑end financial reports, including aging reports, unreconciled claim percentages, and outstanding discrepancies.

• Tracks and reports DIR fee summaries and top DIR fees for each pharmacy location.

• Organizes payer and PBM correspondence and drafts communications related to missing or disputed payments.

• Investigates, tracks, and resolves drug‑related claim denials and billing exceptions across inpatient, outpatient, specialty, and infusion services.

• Reviews high‑cost medication charges to validate billing accuracy against payer rules, contracts, and reimbursement requirements.

• Monitors daily charge edits, financial work queues, and exception reports to identify revenue leakage or billing discrepancies.

• Supports audits, reporting requests, and compliance reviews related to pharmacy revenue cycle activities.

General Responsibilities:

• Performs other duties as assigned.

Minimum Qualifications:

Education: Associate’s degree required.

Experience: At least five (5) years of experience in pharmacy, healthcare billing, pharmacy billing operations, or data analysis required.

License(s)/Certification(s)/Registration(s) Required: Active permit as a Pharmacy Technician by the Oklahoma State Board of Pharmacy within 6 weeks of hire. National Pharmacy Technician Certification (CPhT) and Pharmacy Revenue Cycle Management Certificate required within one year of hire.

Knowledge, Skills and Abilities:  

• Strong knowledge of pharmacy revenue cycle operations, billing workflows, and reimbursement processes across retail, specialty, inpatient, and infusion pharmacy services.

• Demonstrated ability to analyze financial data, reconcile accounts, and identify revenue discrepancies.

• Knowledge of retail pharmacy reconciliation requirements, including PBM payments, e‑vouchers, register transactions, and electronic remittance files.

• Strong attention to detail and commitment to accuracy in financial and billing activities.

• Ability to meet deadlines and manage multiple priorities in a high‑volume environment.

• Proficiency with pharmacy systems, revenue cycle reporting tools, and Microsoft Excel.

• Strong problem‑solving skills with ability to investigate and resolve complex billing issues.

• Ability to communicate effectively with pharmacy staff, payers, PBMs, finance teams, and external partners.

• Ability to work collaboratively across pharmacy, finance, IT, and compliance teams.

• Commitment to compliance, data integrity, and organizational financial stewardship.

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OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.