Manager, Pharmacy Revenue Cycle Operations

Role Overview

• Provide operational leadership across pharmacy revenue cycle functions, including billing, accounts receivable, denial management, cash application, payment posting, and deposit reconciliation activities.
• Oversee pharmacy charging, billing, and reimbursement processes to ensure accurate, timely, and compliant claim submission and payment posting across pharmacy and medical benefit claims.
• May oversee Insurance Verification (IV), benefits investigation, and Prior Authorization (PA) functions to support timely order processing, reimbursement readiness, and reduction of preventable denials.
• Lead denial management and reimbursement optimization efforts by analyzing denial trends, identifying root causes, and implementing corrective action plans to reduce revenue leakage and improve cash performance.
• Partner closely with Pharmacy Operations, Finance, Compliance, and IT teams to standardize revenue cycle workflows, improve operational efficiency, and ensure alignment between billing processes and payer requirements.
• Monitor and optimize accounts receivable performance, including aging trends, underpayments, unresolved balances, unapplied cash, and reimbursement variances.
• Oversee cash application and posting activities to ensure accurate reconciliation of payments, deposits, remittances, and bank activity, while maintaining integrity between subledger and general ledger balances.
• Develop and maintain reporting, dashboards, and key performance indicators (KPIs) related to reimbursement, denial trends, cash collections, posting accuracy, reconciliation performance, and AR outcomes.
• Analyze reimbursement data and operational trends to identify opportunities for revenue capture, process improvement, and financial optimization.
• Ensure compliance with CMS regulations, payer billing requirements, pharmacy billing standards, and internal controls related to revenue cycle operations and cash management activities.
• Collaborate with payer relations, compliance, and operational leadership to resolve escalated reimbursement issues and support payer audit readiness and remediation efforts.
• Support system implementations, workflow enhancements, and automation initiatives related to billing, remittance processing, cash posting, and reconciliation activities.
• Lead, coach, and develop pharmacy revenue cycle staff, establishing productivity standards, quality expectations, and performance management routines to support operational excellence.

Requirements

• 7+ years of experience in healthcare revenue cycle operations, with pharmacy, specialty pharmacy, infusion, retail pharmacy, or DME/pharmacy experience strongly preferred.
• Proven experience overseeing billing, accounts receivable, denial management, cash posting, payment reconciliation, and reimbursement operations in a healthcare environment preferred.
• Strong understanding of pharmacy reimbursement methodologies, payer billing requirements, and revenue cycle workflows across Medicare, Medicaid, Commercial, and PBM payers preferred.
• Working knowledge of pharmacy billing standards, remittance processing, and EDI transactions, including 837/835 and NCPDP-related workflows preferred.
• Experience analyzing denial trends, reimbursement variances, cash reconciliation issues, and operational performance metrics to drive financial improvement initiatives preferred.
• Strong analytical and problem-solving skills with the ability to interpret complex financial, operational, and reimbursement data preferred.
• Demonstrated ability to lead teams, manage cross-functional initiatives, and drive accountability in a fast-paced operational environment preferred.
• Experience partnering with Finance, Pharmacy Operations, Compliance, IT, and payer stakeholders to resolve operational and reimbursement issues preferred.
• Knowledge of CMS regulations, payer requirements, HIPAA, and revenue cycle compliance standards preferred.
• Strong communication, organizational, and project management skills, with the ability to influence stakeholders across multiple levels of the organization preferred.
• Proficiency with revenue cycle systems, pharmacy billing platforms, reporting tools, and Microsoft Office applications, particularly Excel preferred.
• Bachelor’s degree in Healthcare Administration, Business, Finance, Pharmacy, or related field preferred.
• Relevant pharmacy revenue cycle or healthcare financial certifications are a plus preferred.

Benefits

• Medical, dental and vision coverage
• Paid time off plan
• Health savings account (HSA)
• 401k savings plan
• Access to wages before pay day with myFlexPay
• Flexible spending accounts (FSAs)
• Short
• and long-term disability coverage
• Work-Life resources
• Paid parental leave
• Healthy lifestyle programs