Park Nicollet is looking to hire a Pharmacy Revenue Integrity Program Manager to join our team! Come join us as a Partner for Good and help us make an impact on the care and experience that our patients and their families receive every day.
Position Summary:
The Pharmacy Program Manager, Pharmacy Revenue Integrity, leads strategic initiatives that optimize medication reimbursement, strengthen revenue integrity, support regulatory compliance and reduce financial and compliance risk for HealthPartners. This role serves as a subject matter expert and cross-functional leader, connecting Pharmacy, Revenue Cycle, Ambulatory Operations, clinical teams, Contracting, Finance and other stakeholders to identify reimbursement opportunities, resolve complex payment issues, interpret and implement payer and regulatory requirements, and develop sustainable processes that improve financial performance.
Required Qualifications:
Education, Experience or Equivalent Combination:
- B.S. in Pharmacy or PharmD
Licensure/Registration/Certification:
- Licensed pharmacist in the state of MN
Knowledge, Skills, and Abilities:
- Ability to work proficiently in Microsoft Office, Epic and other pharmacy programs
- Knowledge of pharmacy and medical benefit reimbursement, including professional and institutional billing
- Ability to influence without direct authority and collaborate effectively across clinical, operational, and revenue cycle teams
Preferred Qualifications:
Education, Experience or Equivalent Combination:
- Experience in pharmacy revenue integrity, healthcare revenue cycle, or medication reimbursement in the medical benefit setting
- Experience with reimbursement strategy for high-cost specialty medications, biologics, radiopharmaceuticals or other complex products
- Experience with Epic
- Understanding of site of care differences in the medical benefit space
Licensure/Registration/Certification:
- Completion of 340B ACE Program
- Advanced degree in Informatics, Business, Finance, or Health System Pharmacy Administration and Leadership
Knowledge, Skills, and Abilities:
- Understanding of Hospital Outpatient Prospective Payment System (OPPS), Physician Fee Schedule (PFS), and Ambulatory Surgical Center (ASC) payment classifications
- Understanding of 340B program operations, accumulation, eligibility, and reimbursement implications
- Ability to interpret payer policies, CMS requirements, and regulatory guidance and translate requirements into compliant operational workflows
- Flexibility to adapt to changes/challenges in organizational strategy, priorities, or direction and overcome resistance to change
- Understanding of Medicare, Medicaid, commercial, and Medicare Advantage reimbursement methodologies
Benefits:
Park Nicollet offers a competitive benefits package (for eligible positions) that includes medical insurance, dental insurance, a retirement program, time away from work, insurance options, tuition reimbursement, an employee assistance program, and much more!
About UsAt HealthPartners we believe in the power of good – good deeds and good people working together. As part of our team, you’ll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.
We’re a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.
At HealthPartners, everyone is welcome, included and valued. We’re working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.
Benefits Designed to Support Your Total Health
As a HealthPartners colleague, we’re committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.
Join us in our mission to improve the health and well-being of our patients, members, and communities.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.
Skills Required
- Bachelor of Science in Pharmacy or PharmD
- Licensed pharmacist in the state of Minnesota
- Proficiency with Microsoft Office, Epic, and other pharmacy programs
- Knowledge of pharmacy and medical benefit reimbursement, including professional and institutional billing
- Ability to influence without direct authority and collaborate across clinical, operational, and revenue cycle teams
- Experience in pharmacy revenue integrity, healthcare revenue cycle, or medication reimbursement in the medical benefit setting
- Experience with reimbursement strategy for high-cost specialty medications, biologics, radiopharmaceuticals, or other complex products
- Experience with Epic
- Understanding of site-of-care differences in the medical benefit space
- Completion of the 340B ACE Program
- Advanced degree in Informatics, Business, Finance, or Health System Pharmacy Administration and Leadership
- Understanding of OPPS, Physician Fee Schedule, and ASC payment classifications
- Understanding of 340B program operations, accumulation, eligibility, and reimbursement implications
- Ability to interpret payer policies, CMS requirements, and regulatory guidance and translate them into compliant operational workflows
- Flexibility to adapt to organizational strategy, priorities, or direction and overcome resistance to change
- Understanding of Medicare, Medicaid, commercial, and Medicare Advantage reimbursement methodologies
What We Do
HealthPartners, an integrated health care organization providing health care services and health plan financing and administration, was founded in 1957 as a cooperative. It's the largest consumer governed nonprofit health care organization in the nation – serving more than 1.8 million medical and dental health plan members nationwide. Our care system includes a multi-specialty group practice of more than 1,800 physicians that serves more than 1.2 million patients. HealthPartners employs over 26,000 people, all working together to deliver the HealthPartners mission. For more information, visit our company site at https://www.healthpartners.com or our career site at https://www.healthpartners.com/hp/careers.
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