InSync Consulting Services is seeking an experienced System Pharmacy Charge & Compliance Analyst to support medication charge accuracy, billing compliance, and reimbursement processes within a hospital healthcare system. This role focuses on outpatient medication charge capture, revenue integrity, regulatory compliance, and the prevention of billing errors and revenue loss.
The ideal candidate will have recent hands-on IV compounding experience in an inpatient hospital pharmacy or hospital infusion center, along with a strong understanding of medication billing, pharmacy operations, and regulatory requirements.
This is an onsite position in Roseville, CA.
Key Responsibilities
- Review and reconcile medication charges for outpatient hospital services, including infusion clinics, emergency departments, observation units, and outpatient surgery centers.
- Validate National Drug Code (NDC) to Healthcare Common Procedure Coding System (HCPCS) mapping, billable units, and applicable modifiers, including JW and JZ.
- Ensure medication billing practices align with Centers for Medicare & Medicaid Services (CMS), Health Resources and Services Administration (HRSA), payer requirements, and applicable pricing policies.
- Support compliance with 340B, Group Purchasing Organization (GPO), and Wholesale Acquisition Cost (WAC) pricing requirements.
- Identify and correct medication charge capture discrepancies before claims submission.
- Review outpatient medication billing for accuracy, including UB-04 claims, HCPCS codes, revenue codes, and supporting clinical documentation.
- Collaborate with pharmacy operations, revenue integrity, finance, Health Information Management (HIM), and revenue cycle teams to maintain accurate medication charge records.
- Participate in internal and external audits and support audit readiness.
- Investigate medication-related claim denials, underpayments, coding discrepancies, and billing errors.
- Assist with claim adjustments, rebilling, appeals, and corrective actions as appropriate.
- Work with pharmacy procurement, buyers, and compounding teams to evaluate medication utilization, vial usage, and billing implications.
- Support electronic medical record (EMR) upgrades, charge capture mapping, automation rules, and workflow improvements.
- Educate pharmacy and revenue cycle staff on medication charge accuracy, billing practices, and 340B compliance.
- Track charge corrections, denial trends, reimbursement impacts, and opportunities for process improvement.
- Perform other related duties as assigned.
Required Qualifications
- Active state Pharmacy Technician license in California, Oregon, or Hawaii.
- At least three years of experience in hospital or health system pharmacy, revenue integrity, billing, or compliance.
- Recent IV compounding experience within the past 12 months in an inpatient hospital pharmacy or hospital infusion center setting.
- Understanding of hospital pharmacy workflows and medication handling processes.
- Knowledge of medication charge capture, billing accuracy, and regulatory compliance.
- Ability to identify discrepancies, investigate billing issues, and collaborate with cross-functional teams.
Preferred Qualifications
- Experience with pharmacy procurement, medication purchasing, and inventory management.
- Experience in an oncology infusion center.
- Experience filling, replenishing, or managing inventory in Automated Dispensing Cabinets (ADCs).
- Knowledge of medication charges originating from inpatient pharmacy operations.
- Experience with 340B program compliance and audit readiness.
- Experience with Epic Resolute, Cerner Revenue Cycle, or similar EMR and billing systems.
- Pharmacy Technician Board certification.
- Advanced certifications such as CHRI, CRCR, or 340B ACE.
- Associate degree, technical degree, or equivalent combination of education and relevant experience.
Education
- High school diploma or GED preferred.
- Associate degree or technical degree preferred.
Pay: $40.00 - $46.00 per hour
Expected hours: 40.0 per week
Work Location: In person
