Program Manager, Pharmacy Revenue Integrity

Position Summary

The Pharmacy Program Manager, Pharmacy Revenue Integrity, leads strategic initiatives that optimize medication reimbursement, strengthens revenue integrity, supports regulatory compliance and reduces 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

• 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
• Advanced degree in Informatics, Business, Finance, or Health System Pharmacy Administration and Leadership
• 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

About Us

Park Nicollet is a Partner for Good and helps make an impact on the care and experience that our patients and their families receive every day. 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!

Benefits

At HealthPartners, we believe in the power of good – good deeds and good people working together. We are a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.