Revenue Cycle Specialist - Pharmacy - Hybrid

We are recruiting for a motivated Revenue Cycle Specialist - Pharmacy - Hybrid to join our teamWe are here for life's journey.Where is your life journey taking you?Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all:Humanity in action, Triumph in hardship, Transformation in health.DepartmentBilling and CollectionsJob SummaryThe Pharmacy Revenue Cycle Coordinator is responsible for collection and reimbursement activities related to the DHHA pharmacy and DHHA Retail Pharmacy. The person in this position will work to coordinate statement billing activities, account flow to external agencies and facilitate billing and reimbursement knowledge between Hospital and Physicians Business Services (HPBS) and both the Hospital and Retail Pharmacies. This position is responsible for the management of the self-pay account activities located in the retail pharmacy service area. assuring that accounts receive statements are flow to the SBO vendor and ultimately to the bad debt vendor. This position knows the revenue cycle well enough to play a role in pharmacy coding, modifier usage and ultimately code placement on the claim. This position will also understand payer behavior enough to be able to estimate reimbursement for particular drugs, especially 340-B drugs and IV therapy.The position will report to the director of HPBS but will network with pharmacists, chargemaster and coding personnel, vendor management staff and other HPBS staff. The position is self-directed but will be required to meet targets in the Pharmacy Service Area in the Epic physician (PB) billing system.Essential Functions:- Monitor the workflow for self-pay accounts with balances as they go from billed Accounts Receivable (AR) to Bad Debt (BD). Assuring that balances are accurate as they transition in each stage of the workflow. (25%)- Assure that AR moving from the pharmacy insurance billing system to Epic is reconciled and insurance takebacks are resolved, and the AR is billed to the patient. (15%)- Understands pharmaceutical reimbursement for the major payers, Medicaid, Medicare, Aetna, Anthem, United Healthcare, and Cigna. And is able to communicate with the pharmacy the expected payment for drugs and biologicals This will include understanding of reimbursement for high-cost drugs used in IV infusion and cancer treatment. (20%)- Understand and recommend actions required for the correct billing to the major payers, Medicaid, Medicare, Aetna, Anthem, United Healthcare, and Cigna. And is able to communicate with the pharmacy the expected payment for drugs and biologicals This will include understanding of reimbursement for high-cost drugs used in IV infusion and cancer treatment. (20%)- Resolve any credit balances in Epic (20%)Education:- Bachelor's Degree a bachelor's degree in finance, business administration, healthcare administration, nursing, or a related field Required- Master's Degree Preferred- A hospital or medical coding certificate preferredWork Experience:- 4-6 years billing hospital, medical or physician Required and- less than 1 year Billing for pharmaceutical claims - preferredLicenses:- PTCB Education/Training Certificate - PTCB - Pharmacy Technician Certification Board RequiredKnowledge, Skills and Abilities:- A firm understanding of Medical and Hospital coding a coding certificate would be helpful in verification of this skill- Knows the basic formats of the UB04 and the HCFA 1500, with their various fields and form locators- Knows the revenue cycle and where most opportunities for improvement happenShiftDays (United States of America)Work TypeRegularSalary$28.03 - $42.05 / hrBenefitsOur ValuesAll job applicants for safety-sensitive positions must pass a pre-employment drug te t, once a conditional offer of employment has been made.Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.As Colorado's primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community.Applicants will be considered until the position is filled.[](

Created: 2026-01-23