Pharmacy Business Office Manager

Job Summary The Pharmacy Business Office Manager oversees the financial, administrative, and operational functions that support pharmacy revenue cycle performance. This role is responsible for reconciling pharmacy payments, monitoring third‑party payer activity, ensuring accurate claim data, reconciling rebates, and supporting compliance with billing and reimbursement requirements. The manager partners closely with the Administrative Director, Finance Team, and Central Business Office to develop efficient workflows, maintain high‑quality data, and ensure timely and accurate financial processes. Responsibilities Manage and oversee pharmacy payment reconciliation processes, including third‑party payer payments, cash posting, remittance review, and variance resolution. Ensure timely and accurate reconciliation of claims, reimbursements, and adjustments. Identify payer trends, denials, and payment discrepancies; partner with the pharmacy team to resolve issues. Ensure clean, accurate claim, collection, and demographic data supporting pharmacy billing workflows. Assist in analyzing current costs, revenues, financial commitments, and obligations incurred to predict future revenues and expenses. Monitor contract pharmacy performance, payment trends, reconciliation timelines, and fee structures; escalate concerns related to revenue leakage, incorrect fees, or missed opportunities. Support optimization of 340B revenue through identification of process gaps, payer or prescriber issues, or data mismatches that affect savings capture. Develop and report pharmacy‑specific KPIs (e.g., payment accuracy, reconciliation timelines, denial trends). Evaluate processes and make recommendations on changes to enhance quality and efficiency. Assist in the development and maintenance of policies, procedures, and training materials related to pharmacy revenue cycle, billing workflows, reconciliation, and payer compliance. Audit and report monthly pharmacy business KPIs, including reconciliation accuracy, claim volume, payment timelines, and exception trends. Orient all new staff to MAHEC’s clinical policies and procedures. Collaborate regularly with pharmacy leadership, CBO, finance, and compliance teams to improve efficiency and ensure alignment. Maintain understanding of current 340B regulations, manufacturer restrictions, HRSA guidance, and payer carve‑out requirements; update internal processes and communicate changes to pharmacy team. Key Competencies Communication Skills – Effectively and respectfully communicate with colleagues, patients, and families, enumerating information in a manner easily understood by all parties to foster understanding and provide the best care. Decision Making – Make the most appropriate decisions in given situations, prioritize tasks, and ensure timely completion while applying conflict resolution, critical thinking, and confidence. HealthCare Knowledge – Keep abreast of new breakthroughs in the field, maintain licensure and training requirements, and apply knowledge to real‑life scenarios. Interpersonal Skills – Handle difficult situations with grace, professionalism, and empathy; listen effectively and demonstrate responsibility and dependability. Organizational Values – Adhere to MAHEC’s founding principles, demonstrate integrity, accountability, and equitable practices, and manage change. Problem Solving – Think logically to solve complex problems autonomously, drive continuous improvement, and apply new ideas for positive change. Key Skills Excellent Microsoft Office skills (Word, Excel, PowerPoint) and database applications. Physical Demands Not Applicable. Supervisory Responsibilities Not Applicable. Education and Experience Minimum Qualifications: At least 5 years of experience in healthcare revenue cycle, pharmacy billing, pharmacy reimbursement, or financial reconciliation. Demonstrated competency in payment posting, payer processes, and reconciliation workflows. Preferred Qualifications: Bachelor’s degree in Finance, Accounting, Business Administration, Healthcare Administration, or a related field. Knowledge of the 340B drug pricing program. Required Licenses: Not Applicable. Schedule Regular attendance on‑site is an essential function of this position. Typical business hours are Monday – Friday, 8:00am to 5:00pm (or flexed to best meet the needs of the clients and/or the Division); 40 hours per workweek. Weekend, holiday, or evening coverage is occasionally required. Work hours may need to be flexible to respond to special work assignments or evening activities as requested by the team leader. Benefits At MAHEC, we strive to equip all team members with Total Rewards (pay + benefits) to honor their service, support their health, manage their financial security, build their career, and thrive. All MAHEC employees and learners will be required to receive the Flu vaccine or have an approved exemption. Equal Opportunity Employer Equal Opportunity Employer. MAHEC is a qualifying employer for the Public Service Loan Forgiveness (PSLF) Program. Employees who meet federal requirements may be eligible to have remaining student loan balances forgiven after 10 years of qualifying payments while working full‑time at MAHEC. #J-18808-Ljbffr Mountain Area Health Education Center