Pharmacy Revenue Cycle Specialist

The Pharmacy Revenue Cycle Specialist serves as the clinical reimbursement expert within the pharmacy department. This role is responsible for identifying and resolving billing, coding, and documentation issues that impact reimbursement, focusing on both the pharmacy and medical benefit pathways. The pharmacist supports account-level audits, denial appeals, and payer strategy to optimize financial performance and ensure compliance across all billing activities.

Additional Information
Hours per week: 40, eligible for benefits
Shift: Monday - Friday, 8am-5pm. Hours may vary based on the needs of the department.

*This is considered a hybrid position (combination of onsite/remote).

Duties & Responsibilities

• Audits and analyzes patient accounts using the EHR and billing systems to identify and correct coding and charge capture discrepancies impacting reimbursement. Proactively maintains work queues and resolves pharmacy charge errors and basket messages.
• Collaborates cross-functionally with Prior Authorization teams, Revenue Integrity, Charge Capture Auditors, Patient Financial Services, Clinical Application Services, and Purchasing Agents to align on preferred agents, ensure documentation accuracy, and implement systemic improvements that enhance revenue performance.
• Monitors and optimizes billing workflows by leveraging reporting tools and dashboards to evaluate prior authorization processes, denial management, claims correction, and reimbursement trends (e.g. gene therapy, IVIG, and specialty injectables).
• Prepares clinical appeals and supports the resolution of denied claims by drafting compelling, evidence-based letters aligned with FDA labeling, compendia guidance, and payer criteria.
• Interprets and applies payer policies, CMS guidance, and billing requirements including CPT/HCPCS codes, NDC crosswalks, and 340B regulations to support compliant billing practices and ensure appropriate reimbursement for hospital-administered medications.

Minimum Qualifications

• EDUCATION - Doctor of Pharmacy or Bachelor of Science in Pharmacy degree
• EXPERIENCE - Minimum 2 years in health-system pharmacy, managed care, or a payer-facing role with demonstrated revenue cycle responsibilities
• LICENSE - State of Colorado Department of Regulatory Agencies (DORA) Pharmacist license
• Health System Pharmacy Administration and Leadership Residency preferred
• 340B ACE certification and/or ASHP Pharmacy Revenue Cycle certification preferred

Salary Information
Pay is dependent on applicant's relevant experience.

Annual Salary Range (Based on 40 hours worked per week): $130,499.55 to $195,749.32

Benefits Information
Here, you matter. As a Children's Hospital Colorado team member, you will receive a competitive pay and benefits package designed to take care of your needs that includes base pay, incentives, paid time off, medical/dental/vision insurance, company provided life and disability insurance, paid parental leave, 403b employer match (retirement savings), a robust wellness program, and access to professional development tools, including an education benefit to help you advance your career.

As part of our Total Rewards package, Children's Colorado offers an annual employee bonus program that rewards eligible team members based on organizational performance. If organizational goals are met for the year, the bonus is paid out the following April.

Children's Colorado delivers annual base pay increases to eligible team members based on their performance over the previous year.

EEO Statement
It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. Be aware that none of the questions are intended to imply illegal preferences or discrimination based on non-job-related information. The position is expected to stay open until the posted close date. Please submit your application as soon as possible as the posting is subject to close at any time once a sufficient pool of qualified applicants is obtained.

Colorado Residents: In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of attendance at or graduation from an educational institution. You will not be penalized for redacting or removing this information.