Patient Financial Services Specialist - Pharmacy

Patient Financial Services (PFS) Specialist

The Patient Financial Services (PFS) Specialist will lead projects and support the leadership team as a Subject Matter Expert in their field. The Specialist will handle complex issues, investigate denials, identify trends, and hold inter-departmental relationships. The Specialist will maintain internal controls, manage specialized functions and work queues and provide support for special projects.

• Maintain the ability to handle requests from multiple sources and manage multiple deadlines.
• Act as a troubleshooter and resolve issues as they arise, or involve appropriate management personnel as needed.
• Maintain the ability to bring projects to completion timely and identify trends, root causes and efficiency opportunities.

In the pharmacy space, the Specialist will also support complex pharmacy A/R scenarios, including payment posting, credit resolution, and pharmacy-specific collections. This includes navigating PBM (Pharmacy Benefit Managers) and PSAO (Pharmacy Services Administrative Organizations) processes, resolving pharmacy claim rejections, and collaborating closely with clinical and operational pharmacy staff.

Ideal Candidate

• Experience with pharmacy billing within a revenue cycle and/or retail pharmacy environment.
• Exposure to Epic, specifically Willow Ambulatory, is strongly preferred.
• Demonstrated understanding of pharmacy workflows, claims processing, reimbursement, and revenue cycle operations.

What You Will Do

• Acts as subject matter expert in their department, manages projects to timely completion, troubleshoots issues and maintains accurate and compliant workflows.
• Holds inter-departmental relationships within PFS and outside of PFS; manages assigned workflows and work queues associated with these relationships and is the primary communicator with the department for any improvement opportunities.
• Makes sure work queues assigned as their responsibility meet established production and quality standards for the assigned tasks.
• Identifies trends, training opportunities, denial prevention initiatives and maintaining internal controls for the department.
• Performs workflow analysis, documents workflows, and testing planning in support of departments strategic and operational objectives.
• Stays current on regulations and industry standard trends to ensure CHOP is compliant.
• Creates presentations and data analytics to drive change and improvements.
• Documents processes to help keep revenue cycle stakeholders informed and identify optimization opportunities.

Education Qualifications

• A High School Diploma / GED is required.
• A Bachelor's Degree is preferred.

Experience Qualifications

• At least three (3) years of work experience in healthcare billing or collections environment or other related role is required.
• Demonstrated success in resolution of patient accounts; demonstrated ability to identify trends and complete assignments timely is required.

Skills And Abilities

• Strong math aptitude (Required proficiency).
• Excellent organizational skills. (Required proficiency).
• Clear and concise decision making skills (Required proficiency).
• Leadership skills (Required proficiency).
• Detail oriented (Required proficiency).
• String interpersonal skills (Required proficiency).
• Excellent writing and oral communication skills (Required proficiency).
• Ability to work independently; results oriented (Required proficiency).
• Ability to handle confidential matters. (Required proficiency).
• Flexibility to work overtime as needed/required (Required proficiency).
• Experience with personal computers including Excel (Required proficiency).
• Experience with Epic system (Preferred proficiency).

Why This Role Is Exciting

This role offers high visibility, high impact play a key role in optimizing pharmacy revenue by managing payment posting workflows, reconciling credits, and resolving unapplied payments. You’ll directly impact cash flow through A/R follow-up and collections while addressing high-volume pharmacy transactions and ensuring accurate reimbursement. Strategic Collaboration Partner with PBMs (Pharmacy Benefit Managers), PSAOs (Pharmacy Services Administrative Organizations) , and internal clinical and operational pharmacy teams to resolve claim issues, underpayments, prior authorizations, and NDC (National Drug Code) discrepancies. Leverage insights from pharmacy-specific denial trends to escalate systemic issues and drive process improvements that strengthen financial performance and operational efficiency. Mission-Driven Work Your expertise will directly support CHOP’s mission to deliver exceptional care to children and families—making a meaningful difference every day. Growth & Development CHOP is deeply invested in your growth subject matter expert and leader. Beyond internal leadership development, you will receive a complimentary Healthcare Financial Management Association (HFMA) membership, providing access to nationally recognized certifications and a network of experts at the intersection of finance and technology. Community & Purpose Participate in enterprise-wide volunteer opportunities and patient-focused initiatives that allow you to contribute beyond your day-to-day work.

Salary Range

SALARY RANGE: $30.25 - $38.55 Hourly