Pharmacy Tech Revenue Integrity- RX Revenue Integrity at Shannon Health

Job Summary

The Pharmacy Technician, Revenue Integrity is responsible for auditing and supporting end-to-end pharmacy revenue cycle operations. This includes charge capture, benefit investigation, billing integrity, payer compliance, and denials management for infusion, oncology medications, and other medications as identified by Pharmacy Leadership. This role ensures pharmacy revenue integrity by performing pre-billing checks, managing payer requirements, prior authorization, site of care (example transition from infusion to sub q injections), coordinating with clinical and billing teams, and supporting coding accuracy.

Physical Requirements

• The ability to perform the duties and responsibility of the position, with or without reasonable accommodations for disabilities.
• The ability to consistently lift, push or pull loads of up to fifty (50) pounds. (Unless nursing 50)
• Sufficient strength, mobility and stamina to make frequent location and position changes, assist with patient care, and perform other physical activities of average difficulty.
• Candidates whose disabilities make them unable to meet the requirements will still be considered fully qualified if they can perform the essential functions of the job with reasonable accommodations.
• May be exposed to infectious or contagious disease.
• May have to handle emergency situations.
• May be subject to irregular hours.
• May be required to wear protective equipment such as eye protection, face protection, masks, sterile/nonsterile gloves, isolation gowns.
• May be exposed to toxic/caustic/chemicals/detergents.
• Physical activities include continuous sitting, and occasional walking, standing, bending, squatting, climbing, kneeling and twisting.
• Activity Conditions (Occasionally, Frequently, Continuously):
  • Sitting- Continuously
  • Walking- Frequently
  • Standing- Frequently
  • Bending-Frequently
  • Squatting - Occasionally
  • Climbing-Occasionally
  • Kneeling-Occasionally
  • Twisting-Occasionally

Visual and Hearing Requirements

• Must be able to see with corrective eye wear.
• Must be able to hear clearly with assistance.

Working Conditions

Primarily Works in a well-lighted and air-conditioned environment with period of heavy workload and stress. This role may include working in less-than-ideal home conditions, which can include exposure to extreme temperatures and environments that may not meet typical cleanliness standards such as clutter, unkept surfaces, and homes with pets. Works in various conditions.

Performance: Essential Functions

Decision Making: Ability to make decisions and takes appropriate action based on the information they have. Recognizes own limitations and consults with the supervisor, manager, or team member when appropriate.

Time Management: Works efficiently and manages duties to ensure that tasks are completed with accuracy and within the scheduled shift or reasonable amount of time.

Quality & Quantity: Demonstrates accurate, knowledge and skill to carry out job duties. Follows departmental work policies and procedures. Speed and consistency of output and time utilization of job duties.

Computer Knowledge & Electronic Equipment Use: Demonstrates ability to consistently utilize electronic equipment and online computer programs to perform job duties, including electronic documentation, and order entry.

Resource Utilization: Consistently utilizes and maintains supplies and equipment to minimize lost charges and unnecessary equipment repair-replacement.

Confidentiality: Adheres to established policies on privacy and security requirements for compliance with the Health Insurance Portability and Accountability Act (HIPAA), as applicable by Shannon Policy.

Responsibilities
Supervises the Following Positions

Positions: N/A

Performance: Position Specific Essential Functions

• Conducts pre-billing benefit investigations for specialty and infusion medications under both medical and pharmacy benefit.
• Verifies and tracks prior authorization (PA) status.
• Identifies and addresses site-of-care restrictions based on payer policies.
• Supports accurate documentation and charge capture, including validation of NDCs, HCPCS, administration time, wastage (JW/JZ modifiers), and infusion start/stop times.
• Reviews and corrects billing discrepancies.
• Coordinates with billing departments and clinical staff to ensure appropriate coding and billing for medications and infusions.
• Monitors denials by category (PA, medical necessity, coding), conducts root cause analysis, and drafts appeal templates for recurring drug denials.
• Keeps updated on payer policies, including Medicare MAC LCD/NCD updates.
• Manages third-party payer functions, claims reconciliation, and reimbursement tracking.
• Supports 340B program compliance and formulary updates (NDC, HCPCS, additions/deletions).
• Assists in patient assistance program (PAP) operations and revenue recovery initiatives.
• Maintains department work queues and performs regular chart audits.
• Provides technical assistance with Epic Resolute Billing, charge review, and cost reporting.
• Assists pharmacy directors with reporting and administrative tasks.
• Provides training for new team members and supports process improvement.
• Participates in price audits, purchasing cost analysis, and internal controls for pricing accuracy.
• Performs other duties as assigned.

Qualifications

Education

• Required
  
  • High School Diploma, GED, or equivalent

Experience:

• Required
  
  • Three or more years of experience as a pharmacy technician
• Preferred
  
  • Working knowledge of Microsoft products

Certification/Licensure:

• Required
  
  • Registered Pharmacy Technician from the Texas State Board of Pharmacy (TSBP)
  • Certified Pharmacy Technician from Pharmacy Technician Certification Board (PTCB)
    
    • Must obtain within ninety (90) days of start date
• Preferred
  
  • IV Preparation Certification