The Financial Analyst of Pharmacy Services Revenue Integrity supports pharmacy services financial performance across the delivery system through financial reporting, data analysis financial planning, contract proposal evaluations, claims payment accuracy reconciliation and pharmacy payer contract liaison activities. The Financial Analyst extracts and validates data from various information systems and provides actionable information and recommendations through advanced analytics to assist leaders in managing financial performance.
This position is eligible for partial remote work.In addition to adhering to all Fairview policies, guidelines, procedures, the Fairview Commitments, and the Code of Conduct, it is the expectation the following requirements of the remote work policy will be met, including but not limited to:
Remote workspacethat is clean, safe,andprofessional.
Maintains an internetconnection consistent with Fairview standardsat remote workspace.
Remain productive and responsive during their scheduled work hours.
Attend primary Fairview location, as needed.
Analyzing proposals by monitoring payment variances, identify revenue and cost trends.
Track contract performance against projections.
Tracking and updating of all third party payer fee schedules, internal charge masters, and payer contracted payment methodologies.
Reviews charge levels against third party payer contracts, summarizes findings and communicates results to manager and the revenue integrity team.
Administer revenue capture analysis and report by validating reimbursement and investigating claims.
Assist manager in third party payer reimbursement appeals.
Support manager in tracking top contracts, top lines of business and payer mix.
Ad-hoc reporting to identify third party payor populations as needed by leadership.
Review reconciliation of claims activity identifying payment discrepancies and summarize results to Manger, Revenue Integrity Operations Team for action.
Analyze trends to assess efficiency of business activities and recommend plan adjustments or other improvement measures to manager.
Effectively utilizes multiple systems and applications, such as dispensing systems, spreadsheets, and graphic packages to assemble, manipulate and/or format data and reports.
Assist in all revenue integrity operations activities to optimize support and collaboration within Revenue Integrity team.
Maintain up to date knowledge through attending educational workshops and reviewing publications.
Develop subject matter expertise for reimbursement and contracting databases such as Inmar.
Research common third party and health plan claim processing information to ensure accuracy in reporting using payer portal and pharmacy newsletters.
Participates in meetings and revenue integrity projects with internal and external customers.
Bachelors Degree (B.A. or B.S.) Business Management, Accounting, Finance, HealthCare Administration or HealthCare Insurance
1-3 years related experience in financial analysis - preferably with insurance company/payor including both Pharmacy Benefit Manager (PBM) and Health Plan or health care provider system.
Proficient in Microsoft Suite applications such as Excel, Access, PowerPoint, Word
2-4 years experience in health care organization preferred
Certified Pharmacy Technician preferred but not required.
Together with the University of Minnesota and University of Minnesota Physicians we have created M Health Fairview. M Health Fairview is the newly expanded collaboration among the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services. The healthcare system combines the best of academic and community medicine — expanding access to world-class, breakthrough care through our 10 hospitals and 60 clinics.
Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Fairview is one of the most comprehensive and geographically accessible systems in the state, with 10 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area.
Its broad continuum also includes 60 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider network and health insurer PreferredOne. In partnership ...with the University of Minnesota, Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.