Job DescriptionWhat You'll DoPrimary ImpactAs the Manager, Accounts Receivable Operations, you will lead end-to-end third-party pharmacy receivables activities, ensuring accurate reimbursement, timely collections, effective aging management, and exceptional service for pharmacy clients. You will provide strategic leadership to AR teams while serving as the organization's subject matter expert for Medicare Part B reimbursement processes.
Leadership & Team Development- Lead, coach, and develop two AR Supervisors and their respective AR clerk teams, creating a culture of accountability, engagement, and continuous improvement.
- Establish and monitor performance expectations for productivity, quality, follow-up effectiveness, aged receivable resolution, and service delivery.
- Provide ongoing coaching, mentoring, training, and development opportunities that support employee growth and operational excellence.
- Standardize processes, documentation, escalation pathways, and reporting practices across AR teams to drive consistency and scalability.
- Partner with cross-functional stakeholders to resolve reimbursement challenges and improve operational performance.
Third-Party Pharmacy Receivables Management- Oversee all third-party AR activity within TPMS, including payment posting, remittance processing, adjustments, reversals, reconciliations, and account follow-up.
- Monitor AR aging, collections performance, payer trends, denials, underpayments, unapplied cash, and unresolved balances to improve overall reimbursement outcomes.
- Ensure timely and accurate reconciliation of payments received from commercial payers, PBMs, Medicare-related payers, Medicaid programs, and other third-party reimbursement sources.
- Lead root cause analysis efforts to identify reimbursement gaps, collection barriers, and operational improvement opportunities.
- Drive strategies that reduce aged receivables and enhance cash collection performance.
- Manage the MTF/MFP Rebate Program, including tracking, reconciliations, issue resolution, reporting, and collaboration with clients and internal stakeholders.
Medicare Part B Reimbursement Expertise- Serve as the primary subject matter expert for Medicare Part B claims, reimbursement methodologies, denials, documentation requirements, appeals, and escalation processes.
- Guide supervisors and team members on claim resolution strategies and reimbursement best practices.
- Review and resolve highly complex Medicare Part B reimbursement issues and payer escalations.
- Monitor regulatory and reimbursement changes affecting Medicare Part B and implement process, training, and control enhancements as needed.
- Ensure accurate treatment of adjustments, write-offs, account balances, and reimbursement reporting.
Client Partnership & Reporting- Deliver meaningful AR reporting, reimbursement analysis, aging summaries, and collection performance updates to pharmacy clients.
- Support client inquiries related to reimbursement trends, payer research, claim status, denials, and aged balances.
- Partner with internal teams to proactively address client-impacting reimbursement issues and drive timely resolution.
- Support client onboarding, operational transitions, and alignment of reimbursement workflows.
Process Improvement, Compliance & Controls- Develop and maintain SOPs, job aids, training materials, reconciliations, and internal control documentation.
- Identify and implement opportunities to streamline TPMS workflows, reduce manual effort, improve accuracy, and increase operational transparency.
- Ensure processes align with company policies, payer requirements, client obligations, HIPAA standards, audit expectations, and appropriate segregation of duties.
- Support internal and external audits by providing documentation, analysis, and operational expertise related to receivables and reimbursement activities.
Who You AreMinimum Qualifications- Bachelor's degree in Accounting, Finance, Healthcare Administration, Business, or a related field; equivalent relevant experience will be considered.
- 7+ years of progressive experience in accounts receivable, healthcare revenue cycle, pharmacy reimbursement, third-party billing, payer collections, or related functions.
- 3+ years of people leadership experience, including managing supervisors and/or multi-level operational teams.
- Demonstrated expertise in Medicare Part B claims, reimbursement processes, documentation requirements, denials management, appeals, and payer follow-up.
- Strong understanding of pharmacy reimbursement workflows involving commercial payers, PBMs, Medicare, Medicaid, and other third-party payers.
- Experience with payment posting, remittance research, reconciliations, AR aging management, adjustments, write-offs, collections, and denial resolution.
- Advanced analytical, reporting, problem-solving, and Excel skills.
- Strong communication and relationship management skills with the ability to engage clients, operational teams, and senior leadership effectively.
Preferred Qualifications- Experience within specialty pharmacy, retail pharmacy, infusion pharmacy, PBM organizations, or healthcare services environments.
- Knowledge of TPMS or similar pharmacy revenue cycle, reimbursement, or claims reconciliation platforms.
- Experience developing dashboards, KPI reporting, productivity metrics, payer analytics, and aging performance reporting.
- Experience supporting audits, compliance programs, process documentation, and internal controls.
- Knowledge of MTF/MFP rebate programs and related reimbursement workflows.
- Healthcare revenue cycle certification, accounting certification, MBA, or comparable professional credential.
- Proven ability to lead change initiatives and drive operational transformation in complex reimbursement environments.
Success in This RoleSuccess will be measured by:
- Reduction in aged accounts receivable balances, particularly balances exceeding 90 days.
- Improved Medicare Part B reimbursement performance and claim resolution effectiveness.
- Strong leadership and development of supervisors and AR teams.
- Increased visibility into payer trends, denial drivers, underpayments, and collection opportunities.
- Accurate, timely, and actionable client reporting.
- Effective management of the MTF/MFP Rebate Program and related reimbursement activities.
- Enhanced operational controls, compliance readiness, and process consistency across the AR function.
Please note that Omnicell reserves the right to modify job roles and responsibilities as needed to meet our organization's evolving needs and drive our mission forward.
