Job DescriptionThe Pharmacy Program Manager, Pharmacy Revenue Integrity, leads strategic initiatives that optimize medication reimbursement, strengthen revenue integrity, support regulatory compliance and reduce financial and compliance risk 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 implement payer and regulatory 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!
