Program Manager, Pharmacy Revenue Integrity

HealthPartners; Minnesota; On-site; USD 120,000 - 180,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Retirement program

Time away from work

Tuition reimbursement

Employee assistance program

Job summary

Park Nicollet, part of HealthPartners, seeks a Pharmacy Revenue Integrity Program Manager to lead strategic initiatives optimizing reimbursement and strengthening revenue integrity. You will collaborate with Pharmacy, Revenue Cycle, ambulatory operations, clinical teams, contracting and finance to identify opportunities and implement compliant workflows.

The role requires knowledge of pharmacy reimbursement, payer policies, and proficiency with Epic and Office tools, driving financial

Qualifications

• Licensed pharmacist in Minnesota (MN).
• Experience with pharmacy revenue integrity and reimbursement.
• Familiarity with Medicare/Medicaid and commercial payer policies.

Responsibilities

• Lead strategic initiatives to optimize medication reimbursement and strengthen revenue integrity.
• Support regulatory compliance and reduce financial and compliance risk.
• Collaborate across Pharmacy, Revenue Cycle, Ambulatory Operations, clinical teams, Contracting, and Finance.

Skills

Microsoft Office

Epic

Pharmacy reimbursement knowledge

Cross-functional collaboration

Education

B.S. in Pharmacy or PharmD

Advanced degree in Informatics, Business, Finance, or Health System Pharmacy Administration and Leadership

Tools

Epic

Job description

Park Nicollet is looking to hire a Pharmacy Revenue Integrity Program Manager to join our team! Come join us as a Partner for Good and help us make an impact on the care and experience that our patients and their families receive every day.

Position Summary

The Pharmacy Program Manager, Pharmacy Revenue Integrity, leads strategic initiatives that optimize medication reimbursement,strengthenrevenue integrity,supportregulatory compliance andreduce financial and compliancerisk for HealthPartners. This role serves as a subject matter expert and cross-functional leader,connecting Pharmacy, Revenue Cycle, Ambulatory Operations,clinical teams, Contracting, Finance and other stakeholders to identify reimbursement opportunities, resolve complex payment issues,interpret and implementpayer andregulatory requirements, and develop sustainable processes that improve financial performance.

Required Qualifications

Education, Experience or Equivalent Combination

• B.S. in Pharmacy or PharmD

Licensure/Registration/Certification

• Licensed pharmacist in the state of MN

Knowledge, Skills, and Abilities

• Ability to work proficiently in Microsoft Office, Epic and other pharmacy programs
• Knowledge of pharmacy and medical benefit reimbursement, including professional and institutional billing
• Ability to influence without direct authority and collaborate effectively across clinical, operational, and revenue cycle teams

Preferred Qualifications

Education, Experience or Equivalent Combination

• Experience in pharmacy revenue integrity, healthcare revenue cycle, or medication reimbursement in the medical benefit setting
• Experience with reimbursement strategy for high-cost specialty medications, biologics, radiopharmaceuticals or other complex products
• Experience with Epic
• Understanding of site of care differences in the medical benefit space

Licensure/Registration/Certification

• Completion of 340B ACE Program
• Advanced degree in Informatics, Business, Finance, or Health System Pharmacy Administration and Leadership

Knowledge, Skills, and Abilities

• Understanding of Hospital Outpatient Prospective Payment System (OPPS), Physician Fee Schedule (PFS), and Ambulatory Surgical Center (ASC) payment classifications
• Understanding of 340B program operations, accumulation, eligibility, and reimbursement implications
• Ability to interpret payer policies, CMS requirements, and regulatory guidance and translate requirements into compliant operational workflows
• Flexibility to adapt to changes/challenges in organizational strategy, priorities, or direction and overcome resistance to change
• Understanding of Medicare, Medicaid, commercial, and Medicare Advantage reimbursement methodologies

Benefits

Park Nicollet offers a competitive benefits package (for eligible positions) that includes medical insurance, dental insurance, a retirement program, time away from work, insurance options, tuition reimbursement, an employee assistance program, and much more!