Manager, Pharmacy Revenue Operations

Capital Blue Cross•Harrisburg, PA

1d•$102,310 - $190,015•Hybrid

About The Position

This role provides strategic leadership and oversight of pharmacy financial processes and tracking. It ensures accurate administration, reconciliation, accrual, reporting, allocation, and disbursement of pharmacy manufacturer rebates and network rate guarantees across commercial, Medicare, and self-funded lines of business. The Manager is the primary liaison between Pharmacy and relevant business areas, including Finance, Accounting, Actuarial, Information Technology, Underwriting, and the Pharmacy Benefit Manager (PBM), ensuring rebate processes are compliant, auditable, financially accurate, and aligned with contractual and regulatory requirements. The role supports financial reporting, rebate transparency initiatives, and evolving regulatory requirements. The position leads rebate operations, accounting and financial management, compliance and controls, regulatory initiatives, reporting and analytics, and team development. It oversees rebate workflows and financial close activities; works with partners to address discrepancies and data quality; supports audit readiness and regulatory compliance; analyzes rebate performance and presents recommendations; and directs, coaches, and develops team members. The position is classified hybrid and requires onsite work on Tuesdays and Wednesdays in Harrisburg, Pennsylvania. Capital Blue Cross describes a flexible environment that prioritizes employee health and wellbeing, supports community volunteering, and invests in training and continuing education.

Requirements

Minimum 7 years of progressive experience in pharmacy benefit management, healthcare finance, accounting, or rebate operations.
Minimum 3 years of leadership experience managing staff and operational processes.
Experience with pharmacy manufacturer rebates, PBM financial arrangements, or healthcare revenue management.
Experience working cross-functionally with Finance, Actuarial, Underwriting, and Pharmacy teams.
Strong analytical and financial management capabilities.
Advanced problem-solving and process improvement skills.
Ability to translate complex financial data into actionable business insights.
Excellent communication and presentation skills.
Strong project management and organizational capabilities.
Proficiency with Excel, Power BI, Tableau, financial systems, and large healthcare data sets.
Strong understanding of PBM rebate structures, manufacturer contracting, and pharmaceutical economics.
Knowledge of healthcare accounting principles, accrual methodologies, and financial controls.
Understanding of Medicare Part D and commercial pharmacy benefit programs.
Knowledge of healthcare regulatory requirements affecting pharmacy rebate administration.
Familiarity with audit, compliance, and internal control frameworks.
Bachelor's degree in Accounting, Finance, Actuarial Science, Business Administration, Healthcare Administration, Pharmacy Administration, or a related field.

Nice To Haves

MBA or advanced degree.

Responsibilities

Lead end-to-end pharmacy rebate operations, including receipt, validation, allocation, reconciliation, reporting, and settlement of manufacturer rebate payments.
Oversee operational workflows for quarterly and monthly rebate processing.
Ensure rebate data integrity across pharmacy, finance, and accounting systems.
Monitor operational performance and improve efficiency, scalability, and audit readiness.
Collaborate with PBM partners to resolve rebate discrepancies, operational issues, and data quality concerns.
Review rebate accounting activities, including accrual development, journal entries, financial reporting, and reconciliations.
Partner with Finance and Actuarial teams to develop and validate rebate projections and accrual methodologies.
Ensure accurate recording of rebate revenue and allocation across products, groups, and lines of business.
Monitor rebate balances, variances, and trends, and identify and resolve financial discrepancies.
Support month-end, quarter-end, and year-end financial close activities related to pharmacy rebates.
Maintain internal controls governing pharmacy rebate processes and financial transactions.
Assist with internal and external audit responses involving pharmacy rebates, financial reporting, and contractual compliance.
Ensure adherence to accounting standards, regulatory requirements, and organizational policies.
Develop and maintain process documentation, controls, and standard operating procedures.
Establish monitoring and reporting mechanisms to support rebate transparency and audit requirements.
Assess the operational impacts of emerging pharmacy regulations and PBM transparency requirements.
Lead implementation efforts for rebate pass-through models and reporting and audit provisions associated with CAA 2026 and other regulatory mandates.
Participate in cross-functional strategic initiatives involving pharmacy economics, pricing models, and revenue optimization.
Provide subject matter expertise on rebate contracting, administration fees, and financial implications.
Support development of dashboards, performance metrics, and executive reporting on rebate performance and financial outcomes.
Analyze rebate trends, utilization patterns, contract performance, and financial impacts, and present results and recommendations to leadership.
Support underwriting, pricing, finance, and pharmacy strategy initiatives through data-driven analysis.
Direct, coach, and develop team members responsible for rebate administration, accounting, reconciliation, and reporting.
Foster accountability, operational excellence, collaboration, and continuous improvement.
Establish individual and team performance goals aligned with organizational priorities.
Ensure appropriate succession planning and workforce development strategies are in place.