Pharmacy Revenue Integrity Analyst

Job Description

Location: Philadelphia, PA (Hybrid)

We are seeking a Pharmacy Revenue Integrity Analyst to ensure every pharmacy service is accurately charged, compliantly billed, and appropriately reimbursed. This position is a full-time, direct hire opportunity based in Philadelphia, PA. The role reconciles drug purchasing, charge capture, and claims data, strengthens charge description master accuracy, and identifies recovery opportunities across the pharmacy revenue cycle.

This role is well aligned for an analytical revenue integrity professional who enjoys detailed reconciliation work and partnering across departments. The ideal candidate connects pharmacy, revenue cycle, and finance teams, builds trust through accurate and well documented analysis, and turns findings into practical process improvements.

Responsibilities:

• Reconcile drug purchases to charge capture and billed claims and quantify variances
• Audit pharmacy charge description master entries, including HCPCS codes, units, and multiplier accuracy
• Review JW and JZ modifier application for single dose vial waste and resolve recurring application issues
• Identify administered drugs missing charges and route corrections through the appropriate workflow
• Analyze pharmacy denial trends and trace each to its source in charging or documentation
• Support annual CDM review and drug pricing updates against current reimbursement schedules
• Validate NDC to HCPCS crosswalk accuracy across the drug file
• Partner with pharmacy operations on documentation practices that support compliant billing
• Quantify recovery opportunities and track realized recovery against identified opportunity
• Monitor payer policy changes affecting drug reimbursement and assess billing impact
• Prepare revenue integrity reporting for pharmacy and finance leadership
• Support external audit requests with documentation and analysis

Qualifications:

• Bachelor’s degree in health administration, finance, or a related field preferred
• Certified coding or revenue integrity credential preferred
• Minimum of 3 years of revenue integrity, pharmacy billing, or hospital charge capture experience
• Experience auditing a charge description master
• Working knowledge of HCPCS drug coding, NDC to HCPCS crosswalks, and unit multiplier logic
• Familiarity with JW and JZ modifier requirements and single dose vial waste billing
• Understanding of Medicare outpatient drug reimbursement methodology
• Strong analytical skills, with demonstrated ability to reconcile purchasing, charging, and claims data

Schedule:

• Full-time position
• Hybrid schedule based in Philadelphia, PA
• Monday through Friday, standard business hours (Eastern Time)
• 40 hours per week

Salary Range: The salary range for this position is approximately $80,000 – $98,000 annually ($38.46 – $47.12 per hour), based on experience and qualifications.

Interview Process: Selected candidates will participate in a multi-step interview process, including an initial screening with TalentLNX followed by interviews with department leadership.

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and a diverse, inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.