Healthcare Billing Manager

Consonus Pharmacy • Milwaukie, OR

3d

About The Position

Consonus Pharmacy is a closed-door long-term care pharmacy serving nursing facilities, assisted living residents, and their caregivers. The Billing Manager oversees pharmacy claims processing operations and leads a team responsible for accurate, timely claim submission, resolving claim exceptions, meeting payer requirements, and adhering to NCPDP standards. The role works closely with Intake, Customer Accounts, Pharmacy Operations, and Credentialing & Contracting to support accurate reimbursement, compliance, and service for residents, facilities, and payers. It also manages long-term-care-specific reject queues involving transition fills, hospice billing, and facility census changes.

Training is provided in long-term care pharmacy billing, Part D and Medicaid pharmacy rules, Pharmacy NCPDP standards, and the company’s systems and PBM relationships for candidates with strong healthcare billing and leadership backgrounds. Travel to other pharmacy locations may be required.

Requirements

• Bachelor's degree in Healthcare Administration, Business, Finance, or a related field; equivalent experience is considered.
• At least 5 years of experience in healthcare insurance billing, third-party payer billing, healthcare revenue cycle, or PBM/payer operations.
• At least 3 years of supervisory or management experience leading a team, including coaching, performance management, and accountability in a high-volume production environment.
• Strong analytical and problem-solving skills, including the ability to use data to identify trends, root causes, and process improvements.
• Proficiency with billing management systems and reporting tools, and demonstrated ability to adopt automation, workflow tools, or AI-enabled solutions to improve accuracy and efficiency.
• Ability to work under pressure in a fast-paced environment while ensuring timely and accurate billing.
• Certified Pharmacy Technician (CPhT), or willingness to obtain certification within 6 months of hire.

Nice To Haves

• Experience leading 10 or more direct or indirect reports.
• Hands-on knowledge of Medicare Part D and Medicaid eligibility and billing, and dual-eligible populations.

Responsibilities

• Oversee pharmacy claims processing operations, including prescription adjudication, third-party billing, claim rejection management, and reimbursement optimization.
• Lead a team responsible for accurate and timely claim submission and resolution of claim exceptions.
• Ensure compliance with PBM, Medicare Part D, Medicaid, and commercial payer requirements and adherence to NCPDP standards.
• Partner with Intake, Customer Accounts, and Pharmacy Operations to support accurate reimbursement and compliance, minimize claim write-offs, and provide service to residents, facilities, and payers.
• Coordinate with the Credentialing & Contracting team on payer enrollment issues.
• Manage long-term-care-specific reject queues related to transition fills, hospice billing, and facility census changes.
• Travel to other pharmacy locations as required.

Benefits

• Paid training and career advancement opportunities.
• $25,000 toward ongoing education.
• Paid time off combining vacation, sick, and holiday pay in a flexible-use bank.
• Medical, dental, and vision insurance.
• Free access to MDLIVE for health benefits access from anywhere.
• 401(k) with employer match.
• Employee Assistance Program with free counseling and support services.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager