Manager, Pharmacy Revenue Operations

Capital Blue Cross•Harrisburg, PA

1d•Hybrid

About The Position

This role provides strategic leadership, oversight, and continuous improvement 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 serves as the primary liaison between Pharmacy and relevant business areas—including Finance, Accounting, Actuarial, Information Technology, Underwriting, and the Pharmacy Benefit Manager (PBM)—to ensure processes are compliant, auditable, financially accurate, and aligned with contractual and regulatory requirements. The position supports financial reporting, rebate transparency initiatives, and evolving regulatory requirements. The role leads rebate operations, accounting and financial management, compliance and audit readiness, regulatory and strategic initiatives, reporting and analytics, and team leadership. It is classified as hybrid and requires onsite work on Tuesdays and Wednesdays in Harrisburg, Pennsylvania. Capital Blue Cross describes a flexible work 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 impacting 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.
Ability to work onsite Tuesdays and Wednesdays in Harrisburg, Pennsylvania, as required by the hybrid arrangement.

Nice To Haves

MBA or advanced degree.

Responsibilities

Lead end-to-end pharmacy rebate operations, including receipt, validation, allocation, reconciliation, reporting, and financial settlement of manufacturer rebate payments.
Oversee workflows supporting quarterly and monthly rebate processing and ensure rebate data integrity across pharmacy, finance, and accounting systems.
Monitor operational performance and develop improvements to efficiency, scalability, and audit readiness.
Work 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 reconciliation.
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; 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 audits involving pharmacy rebates, financial reporting, and contractual compliance.
Ensure adherence to accounting standards, regulatory requirements, and organizational policies; 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, reporting obligations, 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 expertise on rebate contracting, administration fees, and financial implications.
Support the development of dashboards, performance metrics, and executive reporting on rebate performance and financial outcomes.
Analyze rebate trends, utilization patterns, contract performance, and financial impacts; 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 performance goals and ensure succession planning and workforce development strategies are in place.