Responsibilities/Job Description:
Location: Seven Lakes Pharmacy, Shoreview MN
Hours: 80 hours bi-weekly
Schedule: days
The Manager, Pharmacy 340B Strategy and Reimbursement Operations provides strategic leadership and operational oversight for Fairview Pharmacy Services' 340B reimbursement strategy, with primary accountability for Maximum Fair Price (MFP) readiness, implementation, and manufacturer rebate operations. The role is intentionally designed to provide flexibility to support additional 340B program priorities as organizational capacity and business needs evolve, including contract pharmacy restrictions, manufacturer policy requirements, Medicare Part D repository activity, and other reimbursement, access, or program integrity initiatives. This position serves as a business lead and subject matter expert for MFP and 340B rebate operations while maintaining the agility to support adjacent strategy and reimbursement workstreams. The Manager partners closely with pharmacy operations, information technology, revenue cycle, compliance, manufacturers, payers, covered entities, third-party administrators, dispensing software vendors, and external partners to interpret changing requirements, monitor program performance, mitigate financial and compliance risk, resolve operational issues, and strengthen program controls. Through strategic planning, cross-functional coordination, and disciplined execution, the Manager advances scalable processes that optimize reimbursement recovery, preserve 340B program integrity, support operational excellence, and position the organization to respond effectively to evolving manufacturer, payer, federal, technology-driven, and organizational priorities.
Responsibilities
- Program Leadership & Operations
- Direct operational execution for MFP and manufacturer rebate programs, including claim identification, eligibility validation, data submission, reconciliation, payment validation, issue resolution, and revenue recovery.
- Design, implement, and continuously refine operational workflows, policies, procedures, and internal controls that support accurate, scalable, and compliant program execution.
- Develop performance measures, monitor operational and financial outcomes, and provide clear reporting and recommendations to leadership.
- Identify operational risks, reimbursement gaps, and process improvement opportunities; lead corrective actions that improve program performance, controls, and financial outcomes.
- Serve as the internal subject matter expert for MFP and rebate operations and, as business needs and capacity allow, provide strategic and operational support for adjacent 340B priorities, including manufacturer restrictions, contract pharmacy limitations, Medicare Part D repository processes, and other emerging reimbursement or access initiatives.
- Financial Reconciliation, Data Submission & Revenue Recovery
- Oversee identification, tracking, reconciliation, and validation of MFP refunds, manufacturer rebate submissions, 340B-related claims, and supporting financial transactions.
- Ensure timely and accurate data submission, claim tracking, invoicing, receivable monitoring, and collection of MFP, rebate, and related program payments.
- Review payment variances and investigate discrepancies between expected and received reimbursement.
- Monitor outstanding claims and receivables and implement strategies to optimize revenue recovery.
- Maintain detailed records supporting audit readiness and financial accountability.
- Vendor, Manufacturer & External Partner Management
- Manage relationships with external vendors supporting 340B program operations, rebate administration, repository submissions, claim identification, analytics, eligibility validation, and payment processing.
- Establish service expectations and monitor vendor performance against contractual obligations.
- Collaborate with manufacturers, covered entities, third-party administrators, dispensing software vendors, industry groups, consultants, and other stakeholders as necessary.
- Lead regular vendor business reviews and drive resolution of identified issues.
- Payer, Manufacturer & Program Policy Engagement
- Serve as a primary point of contact for payers, manufacturers, third-party administrators, and internal stakeholders regarding MFP refunds, 340B rebate claims, contract pharmacy restrictions, repository requirements, and related program activity.
- Investigate and resolve claim disputes, denials, payment discrepancies, and operational concerns.
- Coordinate escalation activities when program requirements are not being met.
- Lead communications and negotiations related to claim validation, data requirements, reimbursement accuracy, program access, and operational expectations.
- Good Faith Inquiries, Appeals & Denial Management
- Oversee the review, development, submission, and resolution of Good Faith Inquiries.
- Analyze denied, disputed, or rejected claims and determine appropriate escalation pathways.
- Coordinate appeals, documentation collection, and supporting evidence required for successful resolution.
- Track outcomes and identify trends requiring process improvements or stakeholder intervention.
- Information Technology, Repository Management & Data Governance
- Serve as the primary business liaison between MFP and rebate operations, Medicare Part D repository processes, dispensing systems, third-party administrators, and Information Technology teams.
- Define business requirements for MFP and rebate data extraction, claim validation, repository file generation, reporting, system enhancements, automation efforts, and controls supporting accurate program execution.
- Validate program data and monitor data integrity across multiple systems and vendors.
- Partner with IT to implement new technologies and process improvements supporting program effectiveness.
- Ensure reporting accuracy and maintain appropriate controls over sensitive program data.
- Compliance & Regulatory Oversight
- Monitor federal regulations, CMS guidance, HRSA guidance, manufacturer requirements, contract pharmacy restrictions, Medicare Part D repository expectations, and industry developments affecting MFP, rebate, and related 340B program operations.
- Ensure organizational compliance with applicable program requirements and contractual obligations.
- Collaborate with legal, compliance, audit, and operational leadership to mitigate risk.
- Support internal and external audits and regulatory reviews.
- Develop and maintain policies, procedures, training materials, and compliance documentation.
- Leadership & Collaboration
- Provide leadership, coaching, and development for assigned staff.
- Foster collaboration across pharmacy operations, revenue cycle, finance, compliance, contracting, managed care, and technology teams.
- Lead cross-functional initiatives that advance reimbursement optimization, MFP and rebate operations, and other prioritized 340B strategy workstreams as assigned or as capacity allows.
- Present program performance, risks, opportunities, and recommendations to senior leadership.
Required Qualifications
- B.S./B.A. Bachelor's degree in Business, Finance, Healthcare Administration, Pharmacy, Accounting, Information Systems, or related field.
- 5 years healthcare, pharmacy reimbursement, revenue cycle, payer relations, 340B, government program administration, or related experience.
- 3 years leadership, project leadership, or program management experience.
- Experience working with Medicare, Medicaid, PBMs, manufacturers, or healthcare reimbursement models.
- Experience analyzing complex financial and operational data.
- Knowledge, Skills, and Abilities
- Strong understanding of healthcare reimbursement methodologies and pharmacy claims processing.
- Knowledge of Medicare Part D, MFP requirements, manufacturer rebate models, 340B program requirements, contract pharmacy restrictions, repository requirements, and related regulatory frameworks, with the ability to apply this knowledge across changing program priorities.
- Exceptional analytical, problem-solving, and financial reconciliation skills.
- Ability to interpret regulations and operationalize program requirements.
- Strong project management and organizational skills.
- Excellent communication, negotiation, and relationship management abilities.
- Advanced proficiency in Microsoft Excel, reporting tools, and data analytics. •Ability to work effectively with executive leadership, vendors, payers, manufacturers, and regulatory stakeholders.
- Strong attention to detail and commitment to compliance.
- Apexus Advanced 340B Operations Certificate within 3 Yrs
Preferred Qualifications
- Masters in Business Admin Master's degree in Business Administration (MBA), Healthcare Administration (MHA), Pharmacy Administration, or related field.
- Experience managing vendor partnerships and external stakeholder relationships.
- Experience leading cross-functional initiatives involving technology and operational teams.
- Experience with pharmacy claims adjudication and revenue cycle management.
Qualifications:
$114,857.60- $162,177.60 Annual