Pharmacy Revenue Cycle Manager

Job Description Summary
The Pharmacy Revenue Cycle Manager leads pharmacy revenue cycle and revenue integrity activities across the health system. This position promotes accurate medication charge capture, billing, reimbursement, reconciliation, and financial reporting. The manager partners with Pharmacy, Revenue Cycle, Finance, Information Solutions, Compliance, Managed Care, and operational leaders to reduce revenue leakage, resolve billing issues, improve reimbursement, and maintain regulatory and payer compliance.

Entity
Medical University Hospital Authority (MUHA)

Worker Type
Employee

Worker Sub-Type​
Regular

Cost Center
CC004415 SYS - ICCE - Pharmacy

Pay Rate Type
Salary

Pay Grade
Health-36

Scheduled Weekly Hours
40

Work Shift

Job Description

Pharmacy Revenue Cycle Manager

Position Summary

The Pharmacy Revenue Cycle Manager leads pharmacy revenue cycle and revenue integrity activities across the health system. This position promotes accurate medication charge capture, billing, reimbursement, reconciliation, and financial reporting. The manager partners with Pharmacy, Revenue Cycle, Finance, Information Solutions, Compliance, Managed Care, and operational leaders to reduce revenue leakage, resolve billing issues, improve reimbursement, and maintain regulatory and payer compliance.

Key Responsibilities

- Lead pharmacy revenue cycle activities across hospital, ambulatory, infusion, specialty, retail, and clinic-based services.
- Oversee medication charge capture, billing validation, claim reconciliation, payment variance review, denial analysis, and reimbursement monitoring.
- Identify and address lost revenue, underpayments, duplicate charges, billing errors, write-offs, and other financial leakage.
- Maintain controls supporting accurate medication pricing, coding, documentation, billing, and reimbursement.
- Partner with Pharmacy Informatics and Information Solutions to maintain medication billing configurations, charge codes, units of measure, and system logic.
- Coordinate reviews of HCPCS codes, National Drug Codes, revenue codes, payer requirements, and supporting documentation.
- Evaluate the financial impact of new medications, high-cost therapies, formulary decisions, payer changes, and manufacturer programs.
- Develop dashboards and key performance indicators for revenue, denials, underpayments, charge accuracy, reimbursement, and financial recoveries.
- Support revenue cycle activities related to specialty pharmacy, infusion services, medication management, patient assistance, and 340B operations.
- Lead root-cause analyses and corrective-action plans for recurring billing and reimbursement issues.
- Develop policies, procedures, workflows, audit tools, reporting standards, and internal controls.
- Prepare executive reports and recommendations for pharmacy and organizational leadership.
- Lead, coach, and develop assigned revenue cycle and revenue integrity staff.

Minimum Qualifications

- Degree in Pharmacy, Finance, Accounting, Business Administration, Healthcare Administration, Health Information Management, or a related field.
- Five years of progressive experience in pharmacy operations, healthcare revenue cycle, revenue integrity, reimbursement, billing, finance, or healthcare analytics.
- Experience with medication charging, billing, reimbursement analysis, financial reporting, or revenue reconciliation.
- Demonstrated supervisory, team leadership, or cross-functional project leadership experience.
- Proficiency with Microsoft Excel and healthcare financial or reporting systems.

Preferred Qualifications

- PharmD, MBA, MHA, Master of Finance, or another relevant advanced degree.
- Active pharmacist licensure when required by the position’s scope.
- Experience in an academic medical center, integrated health system, or complex multi-site pharmacy enterprise.
- Knowledge of hospital and professional billing, HCPCS coding, National Drug Codes, revenue codes, payer policies, and medication reimbursement.
- Experience with Epic, Willow, Workday, Power BI, Tableau, or comparable systems.
- Knowledge of specialty pharmacy, infusion billing, high-cost medications, patient assistance, medication management, and 340B operations.
- Relevant certification in revenue cycle, coding, compliance, or project management.

Knowledge, Skills, and Abilities

- Strong knowledge of pharmacy reimbursement and healthcare revenue cycle operations.
- Effective financial analysis, problem-solving, and process-improvement skills.
- Ability to translate payer and regulatory requirements into operational workflows.
- Strong leadership, communication, presentation, and relationship-management skills.
- Demonstrated attention to detail, sound judgment, and commitment to billing accuracy, compliance, and data integrity.
- Ability to manage multiple priorities and collaborate across clinical, operational, financial, technical, and compliance teams.

Additional Job Description
Education: Bachelor's degree or equivalent education and/or relevant work experience Work Experience: 9 years progressive work experience and 4 years management experience

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

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