Position Title: Manager - Pharmacy Revenue Cycle Department: Systems Retail Pharmacy Job Description: General Description: The Pharmacy Revenue Cycle Manager is responsible for ensuring optimal revenue capture for pharmaceuticals across the Health System. This position will serve as a liaison between Pharmacy, Finance, Revenue Integrity, IT, Compliance, and other departments to standardize and optimize pharmacy charging workflows, pharmacy revenue, business processes, billing, denial management, and collections. This role will work with sites, managed care, and the business office to decrease medication-related claim denials and outstanding claims. The manager will provide education to site and system stakeholders to drive optimal revenue capture and act as the system expert on medication-related compliance billing and charging topics. This position will develop policies and/or guidelines to improve revenue integrity, capture, and compliance and participate in the financial analyses of any proposed changes to determine charge and revenue implications related to the pharmacy charge description master (CDM) maintenance and then communicate findings to management and overseeing the implementation of approved recommendations to ensure appropriate revenue capture. Essential Responsibilities: Responsibilities listed in this section are core to the position. Inability to perform these responsibilities, with or without an accommodation, may result in disqualification from the position. Develop policies, guidelines, and procedures for pharmaceutical coding, billing, quality, pricing, charging, and denial management to maximize reimbursement and compliant charging. Develop quality metrics and audit methodologies to drive accuracy and first-time quality for all HCPCS/CPT codes, revenue codes, billable units, multipliers, modifiers, indications, etc. Use analytical tools to audit and analyze pharmacy data elements to ensure accurate billing and maximal revenue capture. Perform quality reviews to ensure that CDM additions, inactivation’s, changes and/or revisions were accurately completed in the hospitals clinical and financial systems. Work with Pharmacy & Therapeutics Committees, Oncology Service Lines, and Managed Care to align formularies. Actively research and stay current with important billing and revenue related compliance and optimization topics to guide appropriate organizational decisions. Participate and lead committees, work groups, process improvement efforts, and educational initiatives to improve pharmacy revenue integrity and the pharmacy billing cycle. Develop process flows, education, and communications to improve revenue integrity and compliance. General Responsibilities: Performs other duties as assigned. Minimum Qualifications: Education: Graduate of an ACPE-accredited College of Pharmacy with a Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy (D.Ph.) degree required. Experience: At least three (3) years of progressive leadership experience required. License(s)/Certification(s)/Registration(s) Required: Licensure as a Pharmacist by the Oklahoma State Board of Pharmacy required. Applicants without an active Oklahoma Pharmacist License must obtain licensure within 90 days of hire. Preceptor certification through the Oklahoma State Board of Pharmacy required within 18 months of hire. Pharmacy Revenue Cycle Management (ASHP) or HFMA certification required within one year. Knowledge, Skills and Abilities: Expert-level understanding of pharmacy revenue cycle operations, billing workflows, and reimbursement processes across retail, specialty, inpatient, and infusion pharmacy services. Demonstrated ability to analyze complex financial data, reconcile health system accounts, and identify systemic revenue discrepancies or leakage. In-depth knowledge of retail pharmacy reconciliation requirements, including PBM payments, e-vouchers, register transactions, and electronic remittance files. Advanced ability to investigate and resolve complex billing issues, utilizing pharmacy systems and revenue cycle reporting tools to drive process improvements. Mastery of Microsoft Excel and Electronic Medical Records, with the ability to leverage data for analytics, reporting, and management presentations. Proven ability to communicate effectively and work collaboratively across pharmacy, finance, IT, and compliance teams, as well as with external payers and PBMs. Strong attention to detail with a commitment to accuracy, data integrity, and organizational financial stewardship in a high-volume, deadline-driven environment. Previous pharmacy practice experience in operations or specialized settings like infusion and oncology, with a focus on compliance and medication-related billing standards. Current OU Health Employees - Please click HERE to login. OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family. OU Health is the state’s only comprehensive academic health system of hospitals, clinics and centers of excellence. With 11,000 employees and more than 1,300 physicians and advanced practice providers, OU Health is home to Oklahoma’s largest doctor network with a complete range of specialty care. OU Health serves Oklahoma and the region with the state’s only freestanding children’s hospital, the only National Cancer Institute-Designated OU Health Stephenson Cancer Center, Oklahoma’s flagship hospital, which serves as the state’s only Level 1 trauma center and Edmond Medical Center in the heart of the Edmond Community. Becker’s Hospital Review named University of Oklahoma Medical Center one of the 100 Great Hospitals in America for 2020. OU Health’s oncology program at OU Health Stephenson Cancer Center was named Oklahoma’s top facility for cancer care by U.S. News & World Report in its 2020-21 rankings. OU Health also was ranked by U.S. News & World Report as high performing in these specialties: Colon Surgery, COPD and Congestive Heart Failure. OU Health’s mission is to lead healthcare in patient care, education and research. Experts in prevention, treatment and cures, our team works to improve lives through innovation in medical care, education and research, while investing in the people, technologies and facilities that will enable us to achieve our goals. We are seeking individuals who have a passion and talent for caring for others. By joining our team, you will provide quality health care to our community through the work you do every day. We provide clinical and non-clinical opportunities to further your career and we invite you to explore our available positions. Equal employment opportunities are provided to all employees and applicants for employment without regard to race, color, religion, gender, national origin, age, disability, sexual orientation, gender identity, genetic information or protected veteran status in accordance with applicable federal laws. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, transfer, leaves of absence, compensation, and training. Reasonable accommodations are made to the known physical and mental limitations of qualified individuals with disabilities.

Manager - Pharmacy Revenue Cycle.

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