Pharmacy Revenue Cycle & Reimbursement Lead

MUSC Health & Medical University of SC; EE. UU.; Presencial; USD 110.000 - 180.000; Jornada completa

Descripción de la vacante

MUSC Health & Medical University of SC seeks a Pharmacy Revenue Cycle Manager to lead revenue cycle and revenue integrity activities across the health system. You will promote accurate charge capture, billing, and reimbursement while partnering with Pharmacy, Revenue Cycle, Finance, and Compliance to reduce leakage and ensure payer compliance.

Responsibilities include leading charge capture, denial analysis, coding reviews, and reconciliation efforts, plus developing dashboards and executive

Formación

• 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.

Responsabilidades

• 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.

Conocimientos

Pharmacy reimbursement knowledge

Revenue cycle analytics

Microsoft Excel proficiency

Cross-functional leadership

Regulatory compliance

Educación

Bachelor's degree in Pharmacy, Finance, Accounting, Business Administration, Healthcare Administration, Health Information Management, or a related field

PharmD, MBA, MHA, Master of Finance, or another relevant advanced degree

Herramientas

Epic ERP

Willow

Workday

Power BI

Tableau

Descripción del empleo

MUSC Health & Medical University of SC seeks a Pharmacy Revenue Cycle Manager to lead revenue cycle and revenue integrity activities across the health system. You will promote accurate charge capture, billing, and reimbursement while partnering with Pharmacy, Revenue Cycle, Finance, and Compliance to reduce leakage and ensure payer compliance.

Responsibilities include leading charge capture, denial analysis, coding reviews, and reconciliation efforts, plus developing dashboards and executive