Pharmacy 340B Strategy & Reimbursement Operations Manager

Fairview Health Services•Shoreview, MN

3d•Onsite

About The Position

The Manager, Pharmacy 340B Strategy and Reimbursement Operations provides strategic leadership and operational oversight for Fairview Pharmacy Services’ 340B reimbursement strategy. The role has primary accountability for Maximum Fair Price (MFP) readiness, implementation, and manufacturer rebate operations, while also supporting additional 340B priorities as organizational capacity and business needs evolve. These may include contract pharmacy restrictions, manufacturer policy requirements, Medicare Part D repository activity, and other reimbursement, access, or program integrity initiatives. The Manager serves as a business lead and subject matter expert for MFP and 340B rebate operations. The role partners with pharmacy operations, information technology, revenue cycle, compliance, manufacturers, payers, covered entities, third-party administrators, dispensing software vendors, and external partners to interpret changing requirements, monitor performance, mitigate financial and compliance risk, resolve operational issues, and strengthen program controls. Through strategic planning, cross-functional coordination, and disciplined execution, the Manager advances scalable processes that optimize reimbursement recovery, preserve 340B program integrity, support operational excellence, and prepare the organization to respond to evolving priorities. Location: Seven Lakes Pharmacy, Shoreview, MN. The position is scheduled for 80 hours bi-weekly on days.

Requirements

Bachelor’s degree in Business, Finance, Healthcare Administration, Pharmacy, Accounting, Information Systems, or a related field.
Five years of experience in healthcare, pharmacy reimbursement, revenue cycle, payer relations, 340B, government program administration, or a related area.
Three years of leadership, project leadership, or program management experience.
Experience working with Medicare, Medicaid, PBMs, manufacturers, or healthcare reimbursement models.
Experience analyzing complex financial and operational data.
Strong understanding of healthcare reimbursement methodologies and pharmacy claims processing.
Knowledge of Medicare Part D, MFP requirements, manufacturer rebate models, 340B program requirements, contract pharmacy restrictions, repository requirements, and related regulatory frameworks, with the ability to apply this knowledge across changing priorities.
Exceptional analytical, problem-solving, and financial reconciliation skills.
Ability to interpret regulations and operationalize program requirements.
Strong project management and organizational skills.
Excellent communication, negotiation, and relationship management abilities.
Advanced proficiency in Microsoft Excel, reporting tools, and data analytics.
Ability to work effectively with executive leadership, vendors, payers, manufacturers, and regulatory stakeholders.
Strong attention to detail and commitment to compliance.
Apexus Advanced 340B Operations Certificate within three years.

Nice To Haves

Master’s degree in Business Administration (MBA), Healthcare Administration (MHA), Pharmacy Administration, or a related field.
Experience managing vendor partnerships and external stakeholder relationships.
Experience leading cross-functional initiatives involving technology and operational teams.
Experience with pharmacy claims adjudication and revenue cycle management.

Responsibilities

Direct operational execution for MFP and manufacturer rebate programs, including claim identification, eligibility validation, data submission, reconciliation, payment validation, issue resolution, and revenue recovery.
Design, implement, and refine operational workflows, policies, procedures, and internal controls for accurate, scalable, and compliant program execution.
Develop performance measures, monitor operational and financial outcomes, and provide reporting and recommendations to leadership.
Identify operational risks, reimbursement gaps, and process improvement opportunities, and lead corrective actions.
Serve as the internal subject matter expert for MFP and rebate operations and support adjacent 340B priorities as business needs and capacity allow.
Oversee identification, tracking, reconciliation, and validation of MFP refunds, manufacturer rebate submissions, 340B-related claims, and supporting financial transactions.
Ensure timely and accurate data submission, claim tracking, invoicing, receivable monitoring, and collection of MFP, rebate, and related program payments.
Review payment variances and investigate discrepancies between expected and received reimbursement.
Monitor outstanding claims and receivables and implement strategies to optimize revenue recovery.
Maintain detailed records supporting audit readiness and financial accountability.
Manage external vendors supporting 340B program operations and monitor performance against service expectations and contractual obligations.
Collaborate with manufacturers, covered entities, third-party administrators, dispensing software vendors, industry groups, consultants, and other stakeholders; lead vendor reviews and issue resolution.
Serve as a primary contact for payers, manufacturers, third-party administrators, and internal stakeholders on MFP refunds, 340B rebate claims, contract pharmacy restrictions, repository requirements, and related activity.
Investigate and resolve claim disputes, denials, payment discrepancies, and operational concerns; coordinate escalations when requirements are not met.
Lead communications and negotiations related to claim validation, data requirements, reimbursement accuracy, program access, and operational expectations.
Oversee review, development, submission, and resolution of Good Faith Inquiries.
Analyze denied, disputed, or rejected claims; coordinate appeals, documentation, and supporting evidence; track outcomes and identify trends for improvement.
Serve as the business liaison among MFP and rebate operations, Medicare Part D repository processes, dispensing systems, third-party administrators, and IT teams.
Define business requirements for data extraction, claim validation, repository file generation, reporting, system enhancements, automation, and operational controls.
Validate program data, monitor data integrity across systems and vendors, and partner with IT on technology and process improvements.
Ensure reporting accuracy and maintain appropriate controls over sensitive program data.
Monitor federal regulations, CMS and HRSA guidance, manufacturer requirements, contract pharmacy restrictions, Medicare Part D repository expectations, and industry developments affecting program operations.
Ensure compliance with applicable program requirements and contractual obligations; collaborate with legal, compliance, audit, and operational leadership to mitigate risk.
Support internal and external audits and regulatory reviews, and develop and maintain policies, procedures, training materials, and compliance documentation.
Provide leadership, coaching, and development for assigned staff.
Foster collaboration across pharmacy operations, revenue cycle, finance, compliance, contracting, managed care, and technology teams.
Lead cross-functional initiatives advancing reimbursement optimization, MFP and rebate operations, and other prioritized 340B strategy workstreams.
Present program performance, risks, opportunities, and recommendations to senior leadership.