JOB SUMMARY:
The Pharmacy Business Office Manager oversees the financial, administrative, and operational functions that support pharmacy revenue cycle performance. This role is responsible for reconciling pharmacy payments, monitoring third-party payer activity, ensuring accurate claim data, reconciling rebates, and supporting compliance with billing and reimbursement requirements. The manager partners closely with the Administrative Director, Finance Team, and Central Business Office to develop efficient workflows, maintain high-quality data, and ensure timely and accurate financial processes.
SPECIFIC RESPONSIBILITIES:
Manages and oversees pharmacy payment reconciliation processes, including third-party payer payments, cash posting, remittance review, and variance resolution. Ensures timely and accurate reconciliation of claims, reimbursements, and adjustments.
Identifies payer trends, denials, and payment discrepancies; partners with the pharmacy team to resolve issues. Ensures clean, accurate claim, collection, and demographic data supporting pharmacy billing workflows.
Assists in analyzing current costs, revenues, financial commitments, and obligations incurred to predict future revenues and expenses.
Monitors contract pharmacy performance, payment trends, reconciliation timelines, and fee structures; escalates concerns related to revenue leakage, incorrect fees, or missed opportunities.
Supports optimization of 340B revenue through identification of process gaps, payer or prescriber issues, or data mismatches that affect savings capture.
Develops and reports pharmacy-specific KPIs (e.g., payment accuracy, reconciliation timelines, denial trends). Evaluates processes and makes recommendations on changes to enhance quality and efficiency. Evaluates and improves workflows to enhance efficiency, accuracy, and compliance.
Assists in the development and maintenance of policies, procedures, and training materials related to pharmacy revenue cycle, billing workflows, reconciliation, and payer compliance. Audits and reports monthly pharmacy business KPIs, including reconciliation accuracy, claim volume, payment timelines, and exception trends. Orients all new staff to MAHEC's clinical policies and procedures.
Collaborates regularly with pharmacy leadership, CBO, finance, and compliance teams to improve efficiency and ensure alignment.
Maintains understanding of current 340B regulations, manufacturer restrictions, HRSA guidance, and payer carve-out requirements; updates internal processes and communicates changes to pharmacy team.
This role description is a general description of the essential job functions. It is not intended to describe all the duties the Business Office Manager may perform.
KEY COMPETENCIES:
Communication Skills
Effectively and respectably communicate with other individuals, whether it be a colleague, patient, or patient's family member and appropriately enumerate information in a manner easily understood by all parties. We do this to foster a culture of understanding between all parties, especially in complex and difficult situations, to ultimately provide the best care possible to our patients and their families.
Decision Making
Ability to make the most appropriate decision in a given situation and then taking the next steps to ensure appropriate and timely completion. This requires conflict resolution skills, critical thinking skills, confidence in your ability to make the right decision in most situations. This also includes ability to prioritize your workday appropriately to ensure the most important tasks are completed on time.
HealthCare Knowledge
Having the drive to keep yourself abreast and up to date on the new breakthroughs in your area of expertise and communicating them to the rest of the team, as appropriate. This also includes keeping up with your licensure and yearly training requirements within your area expertise along with MAHEC's organizational training. Finally, the ability to apply the depth of knowledge maintained and gained through this process in real life scenarios as appropriate.
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