Mgr, Pharmacy Rev Integrity

PRINCETON BAPTIST MEDICAL CENTER; Orlando (FL); On-site; USD 85,000 - 130,000; Full time

Job summary

A leading healthcare provider is seeking a Manager for Pharmacy Revenue Integrity in Orlando. The role involves ensuring optimal revenue capture for pharmaceuticals and managing compliance with billing regulations. Ideal candidates will possess experience in pharmacy operations and revenue cycle management, overseeing crucial audits and staff training to enhance efficiency.

Qualifications

• Minimum of 3 years in pharmacy revenue cycle management.
• Five years in a complex health system preferred.
• Certified Revenue Cycle Specialist (CRCS) preferred.

Responsibilities

• Oversees pharmacy revenue cycle process from charge capture to reimbursement.
• Conducts audits of pharmacy billing and documentation practices.
• Trains staff on revenue cycle processes and compliance.

Skills

Revenue cycle management

Healthcare compliance

Pharmacy operations

Education

Bachelor’s degree in Pharmacy, Healthcare Administration, Business

Master’s degree

Tools

EPIC

Job description

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Position Summary

The Manager, Pharmacy Revenue Integrity, is responsible for ensuring optimal revenue capture for pharmaceuticals across the

health system. This role involves developing and managing revenue integrity programs, maintaining charge description accuracy,

supporting financial operations, and ensuring compliance with billing regulations. The ideal candidate will have a strong background

in pharmacy operations, revenue cycle management, and healthcare compliance.

Responsibilities

Essential Functions.

• Oversees the pharmacy revenue cycle process from charge capture to reimbursement, ensuring accuracy and timeliness at each
  
  

stage.

• Establishes and monitors key performance indicators (KPIs) to measure the effectiveness of revenue integrity initiatives,
  
  

identifying opportunities for improvement.

• Conducts regular audits of pharmacy billing and documentation practices to identify revenue leakage, coding errors, or
  
  

compliance issues, and implements corrective actions.

• Collaborates with pharmacy staff, clinicians, and revenue management teams to improve documentation practices for accurate
  
  

coding and billing.

• Provides training and education to pharmacy staff on revenue cycle processes, documentation requirements, coding guidelines,
  
  

and compliance standards.

• Stays updated on regulations, payer policies, and industry trends related to pharmacy billing and reimbursement, developing
  
  

compliance strategies to mitigate risks.

• Works with payer relations and contracting teams to ensure favorable contract terms and optimal reimbursement rates for
  
  

pharmacy services.

• Maintains and manages the Pharmacy Charge Description Master (CDM) for accuracy and compliance. Performs quality reviews
  
  

to ensure that Pharmacy CDM additions, inactivations, changes, and revisions are accurately completed.

• Collaborates with other departments (finance, revenue management, compliance, IT, clinical operations) to address revenue
  
  

integrity issues and implement system-wide initiatives.

• Continuously assesses and refines revenue cycle processes to optimize performance and achieve organizational goals.
• Oversees personnel management and staff development within the pharmacy revenue integrity program.
• Manages HR functions, including hiring, assignments, coaching, and performance reviews
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal,
  
  

state, and local standards.

• Maintains compliance with all Orlando Health policies and procedures.
• Performs all other duties as assigned.
  
  

Qualifications

Education/Training

• Bachelor’s degree in Pharmacy, Healthcare Administration, Business, or related field required.
• Master’s degree preferred.
  
  

Licensure/Certification

• Certified Revenue Cycle Specialist (CRCS) certification preferred.
  
  

Experience

• Minimum of 3 years of experience in pharmacy revenue cycle management, billing, coding, or related field.
• Five (5) years of progressive work experience in a complex health system, experience with pharmacy finance, data
  
  

analysis, project management, performance improvement and healthcare technology, preferred.

• EPIC experience preferred.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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