Specialist, Retail Pharmacy Revenue - Retail Pharmacy - Mullica Hill

MAJOR FUNCTION:

The Retail Pharmacy Revenue Cycle Specialist is responsible for execution and performance of retail pharmacy revenue cycle operations within Epic Willow Ambulatory (WAM) and Professional Billing (PB). This role owns accounts receivable (A/R) follow-up, payment posting, denial resolution, and payment reconciliation activities to ensure accurate and timely revenue capture for retail pharmacy services.

The position plays a critical role in Inspira Health’s transition from third-party A/R management to an internally operated Epic-based revenue cycle model. The Specialist serves as a key operational liaison between Pharmacy, Revenue Cycle, and Finance, ensuring alignment of claim adjudication, remittance processing, and reconciliation workflows. This role directly contributes to AR reduction, denial prevention, cash acceleration, and overall revenue integrity.

This role is accountable for identifying reimbursement variances and supporting recovery of underpayments and unresolved accounts receivable.

QUALIFICATIONS:

Education & Experience:

- Associate’s or Bachelor’s degree in Business, Healthcare Administration, or related field required.
- Minimum 2 years of experience in healthcare billing, accounts receivable, pharmacy operations, revenue cycle, claims adjudication, or related healthcare financial operations required.
- Experience with pharmacy billing, PBM workflows, prior authorization processes, remittance reconciliation, or denial management strongly preferred.
- Experience interpreting EOBs, claim edits, payment variances, or 835 remittance transactions preferred.
- Experience working within Epic, electronic health records, pharmacy systems, or healthcare financial systems preferred.
- Prior retail pharmacy, ambulatory pharmacy, managed care, health information management, or healthcare reimbursement experience preferred

Certification/Licensure:

- NJ Pharmacy Technician License required within 180 days.
- Certified Pharmacy Technician (PTCB, NHA, or ASHP/ACPE) required
- RHIT/RHIA or Coding Certification (CCS, CPC, COC) required
- PTCB Billing and Reimbursement certificate preferred.

Knowledge & Skills:

- Strong understanding of healthcare revenue cycle processes, including claim adjudication, payment posting, and denial management
- Ability to analyze and reconcile financial transactions with high accuracy
- Proficiency in navigating workqueue-driven workflows within electronic health record systems
- Strong problem-solving and analytical skills
- Effective communication and collaboration across operational and financial teams

Physical Requirements

Place an N, O, F or C in the boxes below

N: Never     O: Occasionally (<20%)    F: Frequently (20%-80%)    C: Constantly >80%)
Lifting <20lbs O Standing O Sitting O Lifting 20-50lbs O Climbing O Kneeling O Lifting>50lbs O Crouching O Reaching O Carrying O Hearing O Walking O Pushing O Talking O Vision O Environmental Conditions Noise O Varied Temperatures O Cleaning Agents O Noxious odors O Patient Exposure O Operative Equipment O
BENEFITS INFORMATION:

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