Denver Health · 1 day ago
Revenue Cycle Specialist - Pharmacy - Must Reside in Colorado -Hybrid
Denver, CO
Full-time
Hybrid
Mid Level
$28.03/hr - $42.05/hr
4+ years expDenver Health is an integrated, high-quality academic health care system that includes a Level I Trauma Center and various health services. They are seeking a Revenue Cycle Specialist - Pharmacy to manage collection and reimbursement activities related to pharmacy billing and facilitate communication between different departments regarding billing and reimbursement processes.
Health CareHospitalMedical
Responsibilities
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%)
Qualification
Required
Bachelor's Degree a bachelor's degree in finance, business administration, healthcare administration, nursing, or a related field
4-6 years billing hospital, medical or physician
PTCB Education/Training Certificate - PTCB - Pharmacy Technician Certification Board
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 happen
Preferred
Master's Degree
A hospital or medical coding certificate
less than 1 year Billing for pharmaceutical claims
Benefits
Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans
Free RTD EcoPass (public transportation)
On-site employee fitness center and wellness classes
Childcare discount programs & exclusive perks on large brands, travel, and more
Tuition reimbursement & assistance
Education & development opportunities including career pathways and coaching
Professional clinical advancement program & shared governance
Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer
Company
Denver Health
Denver Health is a health care organization providing level one care for all, regardless of ability to pay.
5001-10000 employees
Funding
Current Stage
Late StageTotal Funding
$1MKey Investors
Health Resources and Services AdministrationCDA Foundation
2024-11-22Grant· $1M
2024-03-18Grant
Leadership Team
Leticia Leyva
Administrative Director. CEO's Office
Ansar Hassan
Interim CFO / Senior Finance Director
Recent News
2025-10-09
Seattle TechFlash
2025-09-12
Company data provided by crunchbase