Program Manager, Pharmacy Revenue Integrity

JOB DESCRIPTION

Park Nicollet is looking to hire a Pharmacy Revenue Integrity Program Manager to join our team! Come join us as a Partner for Good and help us make an impact on the care and experience that our patients and their families receive every day.

The Pharmacy Program Manager, Pharmacy Revenue Integrity, leads strategic initiatives that optimize medication reimbursement, strengthen revenue integrity, support regulatory compliance and reduce financial and compliance risk for Health Partners. 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.

Education, Experience or Equivalent Combination:

• B.S. in Pharmacy or PharmD

• Licensed pharmacist in the state of MN

• 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

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

• Completion of 340B ACE Program
• 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

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!

At Health Partners we believe in the power of good - good deeds and good people working together. As part of our team, you'll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.

We're 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 Health Partners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.

At Health Partners, everyone is welcome, included and valued. We're working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.

As a Health Partners colleague, we're committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.

Join us in our mission to improve the health and well-being of our patients, members, and communities.

We are an Equal Opportunity Employer and do not…