Pharmacy Revenue Integrity Analyst

Careers close to home and your heart 

Since our founding in 1997, we’ve been making long-term care better for our residents and more rewarding for our team members. We’re a Fortune Best Places to Work in Aging Services, a certified Great Place to Work, and one of Glassdoor’s Top 100 Best Companies to Work. If you’re looking for a place that embraces you for who you are, helps you achieve your full potential, and makes working hard feel less like hard work, then look no further than Trilogy. 

Job Summary: 

The Pharmacy Revenue Integrity Analyst is responsible for ensuring optimal revenue capture based on reimbursement processes within our organization. They ensure that claims are properly reimbursed and processed in accordance with third party payer contracts and company policies and procedures. This role involves reconciling large data sets, reviewing and processing reimbursement reports, and executing on opportunities for improvement. The role will work closely with pharmacy and home office management to ensure efficient and cost-effective delivery of medications to LTC facilities. The role will involve optimizing pharmacy operations, managing insurance claims, monitoring medication usage trends, and implementing strategies to enhance patient care and reduce costs.

Roles and Responsibilities: 

• Audits pharmacy location billing to customers, government, and third-party payers
• Manages and Implements pre-edit solutions via Script IQ
• Works post-edit reporting via Net RX, reconciling changes that need follow up or correction
• Supports pharmacy formulary review to ensure accurate product selection and acquisition values
• Partners with Regional Business Office Coordinators and pharmacy personnel for timely rebilling of suboptimal claims
• Evaluates gross margin reporting and ensures rebilling where applicable to optimize revenue capture
• Analyzes prescription data and medication usage trends to identify opportunities for cost savings, streamline processes, and improve patient outcomes. Generate reports and present findings to pharmacy and home office management to support decision-making
• Supports pharmacy inventory count reconciliation related to revenue cycle management (RCM)
• Reports process improvement and training opportunities to appropriate Operations, Procurement, and/or Revenue Cycle Management teams to improve revenue integrity, capture, and compliance
• Work with cross-functional teams to decrease medication-related claim denials and outstanding claims
• Complies with all Company policies, procedures, rules, and standards and all relevant federal and state regulations governing the dispensing and administration of medications in LTC facilities
• Assists with special projects as needed

Qualifications: 

Education: High School / GED
Experience: 1-3 years in LTC pharmacy
Quality Assurance: Detail-oriented with a focus on accuracy and quality, with the ability to work independently in a fast-paced environment

Licenses and Certifications: 

Certified Pharmacy Technician (CPhT) or similar credential preferred.

Physical Requirements: 
Sitting, standing, bending, reaching, stretching, stooping, walking, and moving intermittently during working hours. Must be able to lift at least 50lbs. Must be able to maintain verbal and written communication with co-workers, supervisors, residents, family members, visitors, vendors, and all business associates outside of the health campus.