Job Requirements
Oversee the financial health and operational performance of the pharmacy service line across the organization. Responsible for budgeting, financial reporting and analytics, revenue cycle management, and charge integrity across inpatient, outpatient, retail, infusion, and physician practice pharmacy settings. Partners with clinical, operational, and Information Technology Services (ITS) leaders to support formulary decision-making, maintain pharmacy billing systems and records, and ensure accurate reimbursement and financial performance. Provides leadership for teams responsible for accounts payable, accounts receivable, Medicare Part D financial activities, and patient prior authorization services.
Primary Responsibilities
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job responsibilities performed.
• Develop, administer, and monitor the annual budget for the pharmacy service line, ensuring alignment with organizational goals and financial performance targets.
• Analyze pharmacy expenditures across inpatient, outpatient, retail, infusion, and physician practice settings, identifying trends, variances, and opportunities for cost optimization.
• Direct the preparation and delivery of financial reports, dashboards, and analytical insights to support operational, financial, and strategic decision-making.
• Oversee charge integrity and revenue cycle processes to ensure accurate billing, coding, reimbursement, and regulatory compliance across all pharmacy care settings.
• Partner with Information Technology Services (ITS) and operational stakeholders to develop, maintain, and optimize pharmacy billing records, charge masters, and related system configurations.
• Manage pharmacy accounts payable and accounts receivable functions, including oversight of Medicare Part D billing and reimbursement activities.
• Lead and develop teams responsible for patient prior authorization services, ensuring timely processing, payer compliance, and exceptional customer service.
• Evaluate and communicate the financial impact of formulary additions, deletions, and utilization management strategies to pharmacy and clinical leadership.
• Collaborate with clinical, operational, and executive leaders to provide financial analysis and performance data that support informed business decisions and strategic initiatives.
• Establish and maintain key performance indicators (KPIs) related to pharmacy financial performance, revenue integrity, reimbursement, and operational efficiency.
• Ensure compliance with applicable healthcare, pharmacy, billing, reimbursement, and financial reporting regulations, policies, and procedures.
• Build, mentor, and lead multidisciplinary teams responsible for financial operations, reporting, analytics, prior authorizations, and revenue cycle support within the pharmacy service line.
• Perform all other duties as assigned.
Work Experience
Education & Experience - Required
• Doctor of Pharmacy (PharmD), MBA, MHA, or master's degree in a related field.
• Five (5) years of progressive experience in pharmacy operations, finance, or revenue cycle management within a hospital or integrated health system.
• Experience with budgeting, financial analysis, reimbursement, and pharmacy billing operations.
Education & Experience - Preferred
• Experience supporting or overseeing a 340B Drug Pricing Program.
• Experience with pharmacy revenue cycle, billing, and reimbursement operations.
• Experience in pharmacy budgeting, financial analysis, and reporting.
• Leadership experience in a multi-site hospital or health system environment.
