Manager, Pharmacy Reimbursement

Beth Israel Lahey Health; Boston (MA); On-site; USD 95,000 - 130,000; Full time

Job summary

Beth Israel Lahey Health is seeking a Manager, Pharmacy Reimbursement to lead the revenue cycle for the pharmacy enterprise with ~ $300 million annual revenue. You will optimize reimbursement, manage denials, and supervise accounts receivable while ensuring compliance and supporting strategic growth.

You will partner with Pharmacy Operations, Finance, Revenue Cycle, 340B, and Compliance teams to develop executive reports, dashboards, and forecasts.

Qualifications

• Bachelor's degree required in Finance, Accounting, Healthcare Administration, Business Administration, Pharmacy, or related field.

Responsibilities

• Lead pharmacy revenue cycle operations, including billing, charge capture, reimbursement, denials management, and accounts receivable performance.
• Develop and implement strategies to optimize revenue, improve collections, reduce revenue leakage, and enhance cash flow.
• Oversee manufacturer rebate programs and Medicare Maximum Fair Price (MFP) financial processes to maximize reimbursement and financial performance.
• Partner with Pharmacy Operations, Finance, Revenue Cycle, 340B, Compliance, and Informatics teams to support operational and growth initiatives.
• Monitor revenue integrity, reimbursement trends, and key performance indicators, providing actionable insights and recommendations.
• Develop executive-level financial reports, dashboards, forecasts, and analyses to support decision-making and strategic planning.
• Recruit, develop, and lead revenue cycle staff while fostering a culture of accountability, service excellence, and continuous improvement.

Skills

Revenue cycle

Financial analysis

Executive reporting

Excel / BI

Leadership

Stakeholder management

Education

Bachelor's degree in Finance/Accounting/Healthcare Administration

Tools

Epic Willow

Beacon

BI tools

Excel

Job description

When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives.

The Manager, Pharmacy Reimbursement leads reimbursement and related analytics operations for a pharmacy enterprise generating approximately $300 million in annual revenue. Reporting to the Director of Pharmacy Finance, this role is responsible for optimizing reimbursement, revenue integrity, manufacturer rebate programs, Medicare Maximum Fair Price (MFP) initiatives, and accounts receivable performance while ensuring regulatory compliance and supporting strategic growth across the pharmacy enterprise.

Job Description

Essential Responsibilities

• Lead pharmacy revenue cycle operations, including billing, charge capture, reimbursement, denials management, and accounts receivable performance.
• Develop and implement strategies to optimize revenue, improve collections, reduce revenue leakage, and enhance cash flow.
• Oversee manufacturer rebate programs and Medicare Maximum Fair Price (MFP) financial processes to maximize reimbursement and financial performance.
• Partner with Pharmacy Operations, Finance, Revenue Cycle, 340B, Compliance, and Informatics teams to support operational and growth initiatives.
• Monitor revenue integrity, reimbursement trends, and key performance indicators, providing actionable insights and recommendations.
• Develop executive-level financial reports, dashboards, forecasts, and analyses to support decision-making and strategic planning.
• Recruit, develop, and lead revenue cycle staff while fostering a culture of accountability, service excellence, and continuous improvement.

Required Qualifications

Education

• Bachelor's degree in Finance, Accounting, Healthcare Administration, Business Administration, Pharmacy, or a related field required.

Experience

• Minimum seven (7) years of progressive experience in pharmacy finance, healthcare finance, reimbursement, revenue cycle, revenue integrity, or related disciplines.
• Minimum three (3) years of leadership or management experience.
• Demonstrated experience developing financial analyses and executive-level reporting.

Knowledge, Skills, and Abilities

• Knowledge of pharmacy reimbursement, revenue cycle management, manufacturer rebates, Medicare Part B and Part D reimbursement, and MFP methodologies.
• Strong analytical, financial modeling, and problem-solving skills.
• Advanced Excel, reporting, and business intelligence capabilities.
• Strong leadership, communication, project management, and stakeholder management skills.
• Ability to lead cross-functional initiatives and drive measurable financial results.

Preferred Qualifications

• MBA, MHA, MS Finance, PharmD, or other relevant advanced degree.
• Experience leading pharmacy revenue cycle functions within large health systems or pharmacy enterprises, contract pharmacy programs and manufacturer rebate programs.
• Experience with Epic Willow, Beacon, and enterprise financial reporting tools.

Pay Range

$95,000.00 USD - $130,000.00 USD

The pay range listed for this position is the annual base salary range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law.

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled