Pharmacy Charge Analyst - CDM

Navajo Preference Employment Act

In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act. Pursuant to this Plan and corresponding TCRHCC Policy, applicants who meet the necessary qualifications for this position and (1) are enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe will be given preference in hiring and employment for this position, (2) are legally married to enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe and meet residency requirements will be given secondary preference, and (3) are enrolled members of other federally-recognized American Indian Tribes will be given tertiary preference. Overview

POSITION SUMMARY

The primary responsibility of the Pharmacy Charge Analyst is the oversight and maintenance of pharmacy-related charging structures within the hospital and ambulatory clinic environments. This role ensures that all pharmacy services, including infusion therapies and high-cost medications, are accurately charged, compliant with regulatory standards, and aligned with payer-specific reimbursement methodologies. The Pharmacy Charge Analyst is responsible for maintaining the integrity of the Charge Description Master (CDM) as it relates to medications, ensuring appropriate mapping of National Drug Codes (NDCs) to HCPCS Level II (J-codes), and validating unit-based charging structures.

The position requires collaboration with Pharmacy leadership, clinical staff, Coding, and Patient Financial Services to ensure appropriate charge capture and billing practices. Within the Tribal/IHS (638) environment, the analyst must also ensure alignment with Indian Health Service (IHS) All-Inclusive Rate (AIR) billing requirements, AHCCCS Medicaid guidelines, Medicare reimbursement methodologies, and other third-party payer policies. The role plays a critical part in minimizing revenue leakage, reducing denials, and supporting the overall financial integrity of TCRHCC.

Qualifications

NECESSARY QUALIFICATIONS

Education

Must have a High School Diploma or GED

Experience

• Minimum two-year experience in healthcare financial services, pharmacy operations, or clinical service areas.
• Minimum one-year experience in chargemaster maintenance, pharmacy billing, infusion services, medical billing, accounts receivable, or coding.
• Demonstrated knowledge of ICD-10, CPT, and HCPCS Level II coding systems.
• Working knowledge of National Drug Code (NDC) structure and crosswalk to HCPCS (J-codes).
• Experience with UB-04 and CMS-1500 billing forms and third-party payer requirements.
• Understanding of Medicare, Medicaid (AHCCCS), and IHS AIR reimbursement methodologies

Other Skills and Abilities

• Detailed knowledge of third-party payment systems, including Medicare, Medicaid, and commercial payers.
• Strong analytical and problem-solving skills.
• Ability to perform financial and operational analysis using spreadsheets and reporting tools.
• Effective communication and interpersonal skills with the ability to work across departments.
• Ability to lead training sessions and communicate regulatory changes.
• Reliable and dependable with strong attention to detail.
• Ability to work under pressure and manage multiple priorities.
• Demonstrates high ethical standards and professionalism.
• Ability to interpret system reports and resolve charge and billing discrepancies.
• Completion of and above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the job.
• Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job.
• Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job.
• Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading or incomplete information, as determined by TCRHCC.

PREFERRED QUALIFICATIONS

Education

Associate’s degree or higher in Healthcare Administration, Pharmacy Technology, Nursing, Finance, or related field.

Experience

• Experience in an IHS, Tribal, or Federally Qualified Health Center (FQHC) environment.
• Experience with Sunrise Financial Manager (SFM) or similar systems.

License/certification

Certification such as CCS, CPC, CRCR, or CPhT.

Other Skills and Abilities

Ability to speak Navajo, Hopi, or San Juan Southern Paiute.

Responsibilities

ESSENTIAL FUNCTIONS

• Analyzes and verifies pharmacy charge selection accuracy across clinical service areas.
• Maintains and updates pharmacy-related CDM entries, including infusion drugs and high-cost medications.
• Ensures accurate mapping of NDCs to HCPCS (J-codes) and validates billing units.
• Monitors CMS, AHCCCS, and payer updates and implements required CDM changes.
• Collaborates with Pharmacy to ensure proper build of medications prior to use.
• Supports appropriate billing methodologies for AIR and non-AIR services.
• Analyzes denials, underpayments, and billing discrepancies related to pharmacy services.
• Identifies and resolves revenue leakage related to incorrect units, missing charges, or coding errors.
• Works with Coding and PFS teams to resolve claim edits and denials.
• Develops and implements staff training related to pharmacy charging and documentation.
• Maintains tracking tools for regulatory changes and compliance requirements.
• Prepares reports related to pharmacy revenue, denials, and trends.
• Supports system testing, upgrades, and CDM maintenance initiatives.
• Participates in audits and compliance reviews.
• Ensures timely and accurate charge entry to prevent late charges.
• Develops collaborative relationships with all departments.
• Performs other duties as assigned.

ESSENTIAL FUNCTIONS

• Analyzes and verifies pharmacy charge selection accuracy across clinical service areas.
• Maintains and updates pharmacy-related CDM entries, including infusion drugs and high-cost medications.
• Ensures accurate mapping of NDCs to HCPCS (J-codes) and validates billing units.
• Monitors CMS, AHCCCS, and payer updates and implements required CDM changes.
• Collaborates with Pharmacy to ensure proper build of medications prior to use.
• Supports appropriate billing methodologies for AIR and non-AIR services.
• Analyzes denials, underpayments, and billing discrepancies related to pharmacy services.
• Identifies and resolves revenue leakage related to incorrect units, missing charges, or coding errors.
• Works with Coding and PFS teams to resolve claim edits and denials.
• Develops and implements staff training related to pharmacy charging and documentation.
• Maintains tracking tools for regulatory changes and compliance requirements.
• Prepares reports related to pharmacy revenue, denials, and trends.
• Supports system testing, upgrades, and CDM maintenance initiatives.
• Participates in audits and compliance reviews.
• Ensures timely and accurate charge entry to prevent late charges.
• Develops collaborative relationships with all departments.
• Performs other duties as assigned.

NECESSARY QUALIFICATIONS

Education

Must have a High School Diploma or GED

Experience

• Minimum two-year experience in healthcare financial services, pharmacy operations, or clinical service areas.
• Minimum one-year experience in chargemaster maintenance, pharmacy billing, infusion services, medical billing, accounts receivable, or coding.
• Demonstrated knowledge of ICD-10, CPT, and HCPCS Level II coding systems.
• Working knowledge of National Drug Code (NDC) structure and crosswalk to HCPCS (J-codes).
• Experience with UB-04 and CMS-1500 billing forms and third-party payer requirements.
• Understanding of Medicare, Medicaid (AHCCCS), and IHS AIR reimbursement methodologies

Other Skills and Abilities

• Detailed knowledge of third-party payment systems, including Medicare, Medicaid, and commercial payers.
• Strong analytical and problem-solving skills.
• Ability to perform financial and operational analysis using spreadsheets and reporting tools.
• Effective communication and interpersonal skills with the ability to work across departments.
• Ability to lead training sessions and communicate regulatory changes.
• Reliable and dependable with strong attention to detail.
• Ability to work under pressure and manage multiple priorities.
• Demonstrates high ethical standards and professionalism.
• Ability to interpret system reports and resolve charge and billing discrepancies.
• Completion of and above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the job.
• Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job.
• Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job.
• Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading or incomplete information, as determined by TCRHCC.

PREFERRED QUALIFICATIONS

Education

Associate's degree or higher in Healthcare Administration, Pharmacy Technology, Nursing, Finance, or related field.

Experience

• Experience in an IHS, Tribal, or Federally Qualified Health Center (FQHC) environment.
• Experience with Sunrise Financial Manager (SFM) or similar systems.

License/certification

Certification such as CCS, CPC, CRCR, or CPhT.

Other Skills and Abilities

Ability to speak Navajo, Hopi, or San Juan Southern Paiute.