[Remote] Pharmacy Revenue & Reimbursement Analyst

Note: The job is a remote job and is open to candidates in USA. Texas Health Resources is seeking a Pharmacy Revenue & Reimbursement Analyst to contribute to their revenue cycle team. The role involves facilitating claims processing, analyzing reimbursement accuracy, and supporting 340B revenue optimization activities.ResponsibilitiesFacilitate and support claims processing, rebills, appeals, and follow-up with PBMs and health plans; identify appeal opportunities and manage payor communications to recover underpayments or resolve payment variancesMonitor and report aging accounts receivable and key performance metrics (e.g., DSO, applied cash)Support 340B revenue optimization activities by monitoring payor and accumulator impacts (where applicable), identifying claim-level variances, and collaborating with pharmacy operations and finance to resolve 340B-related reimbursement issuesDevelop reports, dashboards, and ad-hoc analysis for payment variances, denials, underpayments, and other trends to support decision-making and process improvementsIdentify trends related to denials and underpayments; collaborate with appropriate teams to implement improvement initiativesAnalyze reimbursement from pharmacy claims to validate payment accuracy, ensure compliance with contracted rates, and reconcile claims activity with remittances to ensure payment efficacyPerform 340B payment integrity and audit support activities by analyzing claim-level eligibility/accumulator impacts (as applicable), researching exceptions, and preparing documentation for internal/external reviewsSupport 340B split billing and vendor processes (as applicable), including data validation, claim qualification troubleshooting, and reconciliation of replenishment/accumulation outputsSupport maintenance of third-party payor pharmacy fee schedules, pharmacy charge masters, and contracted pharmacy payment methodologies; evaluate payor contract performance and reimbursement arrangements and support negotiations with data-driven insightsProvide education stakeholders to drive optimal revenue captureServe as the system expert on medication-related compliance billing and charging topicsDevelop policies and/or guidelines to improve revenue integrity, charge capture, and billing complianceActively research and stay current with important pharmacy billing and revenue related compliance and optimization topics to guide appropriate organizational decisionsSkillsBachelor's Degree Business, Finance, Analytics, Healthcare Administration, Accounting, or related fieldH.S. Diploma or Equivalent 10 Years CPhT with 10+ years of experience with pharmacy revenue cycle, retail pharmacy operations and billing, as well as 340B3 Years Experience in healthcare and/or pharmacy reimbursement, revenue cycle, or financial analysis; experience working with PBMs, health plans, or healthcare provider systemsCPhT - Certified Pharmacy Technician Upon HireASHP Pharmacy Revenue Cycle Certificate 12 MonthsExtensive knowledge of pharmacy revenue cycle processes, to include PBM contracting, and 340B program concepts such as eligibility/qualifications, split billing, accumulation, replenishment, etcUnderstanding of laws and regulations impacting pharmacy billing and 340BDemonstrate intrapersonal skills, a positive demeanor, professional skills/approach, good verbal and written communication skills, as well as initiative and self-motivationMust be detail oriented and have strong analytical, critical, and problem-solving skills to support leadership decision makingPossess ability to work independently, proactively with limited supervision and as a team player when called upon5 Years Pharmacy reimbursement analysis, collections, or revenue integrity experience; 340B program experience (e.g., split billing/accumulation oversight, claim qualification troubleshooting, audit support, or contract pharmacy operations)Epic ExperienceCompany OverviewTexas Health Resources is a provider of health and wellness resources. It was founded in 1997, and is headquartered in Arlington, Texas, USA, with a workforce of 10001+ employees. Its website is https://www.texashealth.org/.Company H1B SponsorshipTexas Health Resources has a track record of offering H1B sponsorships, with 2 in 2026, 12 in 2025, 8 in 2024, 7 in 2023, 14 in 2022, 7 in 2021, 8 in 2020. Please note that this does not guarantee sponsorship for this specific role.