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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