Pharmacy Revenue Cycle & Integrity Lead

Medical University of South Carolina; United States; On-site; USD 120,000 - 180,000; Full time

Job summary

The Medical University of South Carolina seeks a Pharmacy Revenue Cycle Manager to lead revenue cycle and revenue integrity across the health system. You will drive accurate charge capture, billing, reimbursement, and financial reporting while partnering with Pharmacy, Revenue Cycle, Finance, and IT teams.

In this role, you will oversee charge capture, claim reconciliation, denial analysis, and reimbursement monitoring, while developing dashboards and KPIs to reduce revenue leakage and ensure

Qualifications

• Degree in Pharmacy, Finance, Accounting, Business Administration, Healthcare Administration, Health Information Management, or related field.
• Five years of progressive experience in pharmacy operations, healthcare revenue cycle, revenue integrity, reimbursement, billing, finance, or healthcare analytics.
• Experience with medication charging, billing, reimbursement analysis, financial reporting, or revenue reconciliation.
• Demonstrated supervisory, team leadership, or cross-functional project leadership experience.
• Proficiency with Microsoft Excel and healthcare financial or reporting systems.

Responsibilities

• Lead pharmacy revenue cycle activities across hospital, ambulatory, infusion, specialty, retail, and clinic-based services.
• Oversee medication charge capture, billing validation, claim reconciliation, payment variance review, denial analysis, and reimbursement monitoring.
• Identify and address lost revenue, underpayments, duplicate charges, billing errors, write-offs, and other financial leakage.
• Maintain controls supporting accurate medication pricing, coding, documentation, billing, and reimbursement.
• Partner with Pharmacy Informatics and Information Solutions to maintain medication billing configurations, charge codes, units of measure, and system logic.
• Coordinate reviews of HCPCS codes, National Drug Codes, revenue codes, payer requirements, and supporting documentation.
• Evaluate the financial impact of new medications, high-cost therapies, formulary decisions, payer changes, and manufacturer programs.
• Develop dashboards and key performance indicators for revenue, denials, underpayments, charge accuracy, reimbursement, and financial recoveries.
• Support revenue cycle activities related to specialty pharmacy, infusion services, medication management, patient assistance, and 340B operations.
• Lead root-cause analyses and corrective-action plans for recurring billing and reimbursement issues.
• Develop policies, procedures, workflows, audit tools, reporting standards, and internal controls.
• Prepare executive reports and recommendations for pharmacy and organizational leadership.
• Lead, coach, and develop assigned revenue cycle and revenue integrity staff.

Skills

Pharmacy reimbursement

Healthcare revenue cycle

Financial analysis

Process improvement

Education

Bachelor’s degree or related field

Advanced degree (PharmD/MBA/MHA)

Tools

Epic

Willow

Workday

Power BI

Tableau

Job description

The Medical University of South Carolina seeks a Pharmacy Revenue Cycle Manager to lead revenue cycle and revenue integrity across the health system. You will drive accurate charge capture, billing, reimbursement, and financial reporting while partnering with Pharmacy, Revenue Cycle, Finance, and IT teams.

In this role, you will oversee charge capture, claim reconciliation, denial analysis, and reimbursement monitoring, while developing dashboards and KPIs to reduce revenue leakage and ensure