Mgr, Pharmacy Rev Integrity

Position Summary Manager, Pharmacy Revenue Integrity Position Overview The Manager, Pharmacy Revenue Integrity is responsible for ensuring optimal revenue capture for pharmaceuticals across the health system. This role involves: • Developing and managing revenue integrity programs • Maintaining charge description accuracy • Supporting financial operations • Ensuring compliance with billing regulations The ideal candidate will have a strong background in pharmacy operations, revenue cycle management, and healthcare compliance. Schedule: Hybrid/Remote Benefits That Start Day One! Medical, Dental, Vision Insurance 403(b) Retirement Savings Plan HSA & FSA Options Up to 5 Weeks PTO Paid Parental Leave & Family Care Support Life Insurance & Extended Leave Plan Pet & Car Insurance 100% Paid Tuition + Loan Repayment Assistance Responsibilities Essential Functions • Oversee the pharmacy revenue cycle process from charge capture to reimbursement, ensuring accuracy and timeliness at each stage. • Establish and monitor key performance indicators (KPIs) to measure the effectiveness of revenue integrity initiatives and identify opportunities for improvement. • Conduct regular audits of pharmacy billing and documentation practices to identify revenue leakage, coding errors, or compliance issues, and implement corrective actions. • Collaborate with pharmacy staff, clinicians, and revenue management teams to improve documentation practices for accurate coding and billing. • Provide training and education to pharmacy staff on revenue cycle processes, documentation requirements, coding guidelines, and compliance standards. • Stay updated on regulations, payer policies, and industry trends related to pharmacy billing and reimbursement, developing compliance strategies to mitigate risks. • Work with payer relations and contracting teams to ensure favorable contract terms and optimal reimbursement rates for pharmacy services. • Maintain and manage the Pharmacy Charge Description Master (CDM) for accuracy and compliance, performing quality reviews to ensure all additions, inactivations, changes, and revisions are accurately completed. • Collaborate with other departments (finance, revenue management, compliance, IT, clinical operations) to address revenue integrity issues and implement system-wide initiatives. • Continuously assess and refine revenue cycle processes to optimize performance and achieve organizational goals. • Oversee personnel management and staff development within the pharmacy revenue integrity program. • Manage HR functions, including hiring, assignments, coaching, and performance reviews. • Maintain regular, punctual attendance consistent with Orlando Health policies and applicable federal, state, and local standards. • Ensure compliance with all Orlando Health policies and procedures. • Perform other duties as assigned. Qualifications Education & Training • Bachelor’s degree in Pharmacy, Healthcare Administration, Business, or related field required • Master’s degree preferred Licensure/Certification • Certified Revenue Cycle Specialist (CRCS) certification preferred Experience • Minimum of 3 years of experience in pharmacy revenue cycle management, billing, coding, or related field • 5 years of progressive work experience in a complex health system preferred, including: • Pharmacy finance • Data analysis • Project management • Performance improvement • Healthcare technology • EPIC experience preferred Qualifications:Education & Training • Bachelor’s degree in Pharmacy, Healthcare Administration, Business, or related field required • Master’s degree preferred Licensure/Certification • Certified Revenue Cycle Specialist (CRCS) certification preferred Experience • Minimum of 3 years of experience in pharmacy revenue cycle management, billing, coding, or related field • 5 years of progressive work experience in a complex health system preferred, including: • Pharmacy finance • Data analysis • Project management • Performance improvement • Healthcare technology • EPIC experience preferred Education:UNAVAILABLEEmployment Type: UNAVAILABLE Apply Now Apply Now