Manager, Pharmacy Revenue Cycle Operations

Cardinal Health•Doral, FL

7d•$87,700 - $112,770•Hybrid

About The Position

The Manager, Pharmacy Revenue Cycle Operations is responsible for overseeing and optimizing the financial lifecycle of pharmacy services, ensuring accurate, compliant billing and reimbursement while driving operational efficiency and cash performance. This role provides operational leadership across pharmacy revenue cycle functions, including billing, accounts receivable, denial management, cash application, posting accuracy, and deposit reconciliation processes, and oversight of outsourced revenue cycle vendors. The role serves as a key liaison between Pharmacy Operations, Revenue Cycle, Finance, IT and external vendor partners to standardize workflows, improve revenue integrity, and support accurate reimbursement in alignment with payer and regulatory requirements. Responsibilities include identifying and resolving reimbursement issues, analyzing payment trends, optimizing charging and billing workflows, and implementing process improvements to reduce revenue leakage and strengthen financial performance. This position requires strong knowledge of pharmacy reimbursement methodologies, payer billing requirements, and revenue cycle operations, along with the ability to leverage analytics and cross-functional collaboration to drive sustainable operational and financial outcomes.

Requirements

7+ years of experience in healthcare revenue cycle operations, with pharmacy, specialty pharmacy, infusion, retail pharmacy, or DME/pharmacy experience strongly preferred.
Proven experience overseeing billing, accounts receivable, denial management, cash posting, payment reconciliation, and reimbursement operations in a healthcare environment preferred.
Strong understanding of pharmacy reimbursement methodologies, payer billing requirements, and revenue cycle workflows across Medicare, Medicaid, Commercial, and PBM payers preferred.
Working knowledge of pharmacy billing standards, remittance processing, and EDI transactions, including 837/835 and NCPDP-related workflows preferred.
Experience analyzing denial trends, reimbursement variances, cash reconciliation issues, and operational performance metrics to drive financial improvement initiatives preferred.
Strong analytical and problem-solving skills with the ability to interpret complex financial, operational, and reimbursement data preferred.
Demonstrated ability to lead teams, manage cross-functional initiatives, and drive accountability in a fast-paced operational environment preferred.
Experience partnering with Finance, Pharmacy Operations, Compliance, IT, and payer stakeholders to resolve operational and reimbursement issues preferred.
Knowledge of CMS regulations, payer requirements, HIPAA, and revenue cycle compliance standards preferred.
Strong communication, organizational, and project management skills, with the ability to influence stakeholders across multiple levels of the organization preferred.
Proficiency with revenue cycle systems, pharmacy billing platforms, reporting tools, and Microsoft Office applications, particularly Excel preferred.
Bachelor’s degree in Healthcare Administration, Business, Finance, Pharmacy, or related field preferred.
Relevant pharmacy revenue cycle or healthcare financial certifications are a plus preferred.

Responsibilities

Provide operational leadership across pharmacy revenue cycle functions, including billing, accounts receivable, denial management, cash application, payment posting, and deposit reconciliation activities.
Oversee pharmacy charging, billing, and reimbursement processes to ensure accurate, timely, and compliant claim submission and payment posting across pharmacy and medical benefit claims.
May oversee Insurance Verification (IV), benefits investigation, and Prior Authorization (PA) functions to support timely order processing, reimbursement readiness, and reduction of preventable denials.
Lead denial management and reimbursement optimization efforts by analyzing denial trends, identifying root causes, and implementing corrective action plans to reduce revenue leakage and improve cash performance.
Partner closely with Pharmacy Operations, Finance, Compliance, and IT teams to standardize revenue cycle workflows, improve operational efficiency, and ensure alignment between billing processes and payer requirements.
Monitor and optimize accounts receivable performance, including aging trends, underpayments, unresolved balances, unapplied cash, and reimbursement variances.
Oversee cash application and posting activities to ensure accurate reconciliation of payments, deposits, remittances, and bank activity, while maintaining integrity between subledger and general ledger balances.
Develop and maintain reporting, dashboards, and key performance indicators (KPIs) related to reimbursement, denial trends, cash collections, posting accuracy, reconciliation performance, and AR outcomes.
Analyze reimbursement data and operational trends to identify opportunities for revenue capture, process improvement, and financial optimization.
Ensure compliance with CMS regulations, payer billing requirements, pharmacy billing standards, and internal controls related to revenue cycle operations and cash management activities.
Collaborate with payer relations, compliance, and operational leadership to resolve escalated reimbursement issues and support payer audit readiness and remediation efforts.
Support system implementations, workflow enhancements, and automation initiatives related to billing, remittance processing, cash posting, and reconciliation activities.
Lead, coach, and develop pharmacy revenue cycle staff, establishing productivity standards, quality expectations, and performance management routines to support operational excellence.