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.

SPECIFIC RESPONSIBILITIES:

• Manages and oversees pharmacy payment reconciliation processes, including third-party payer payments, cash posting, remittance review, and variance resolution.
• Ensures timely and accurate reconciliation of claims, reimbursements, and adjustments.
• Identifies payer trends, denials, and payment discrepancies; partners with the pharmacy team to resolve issues.
• Ensures clean, accurate claim, collection, and demographic data supporting pharmacy billing workflows.
• Assists in analyzing current costs, revenues, financial commitments, and obligations incurred to predict future revenues and expenses.
• Monitors contract pharmacy performance, payment trends, reconciliation timelines, and fee structures; escalates concerns related to revenue leakage, incorrect fees, or missed opportunities.
• Supports optimization of 340B revenue through identification of process gaps, payer or prescriber issues, or data mismatches that affect savings capture.
• Develops and reports pharmacy-specific KPIs (e.g., payment accuracy, reconciliation timelines, denial trends). Evaluates processes and makes recommendations on changes to enhance quality and efficiency.
• Evaluates and improves workflows to enhance efficiency, accuracy, and compliance..
• Assists in the development and maintenance of policies, procedures, and training materials related to pharmacy revenue cycle, billing workflows, reconciliation, and payer compliance.
• Audits and reports monthly pharmacy business KPIs, including reconciliation accuracy, claim volume, payment timelines, and exception trends. Orients all new staff to MAHEC's clinical policies and procedures.
• Collaborates regularly with pharmacy leadership, CBO, finance, and compliance teams to improve efficiency and ensure alignment
• Maintains understanding of current 340B regulations, manufacturer restrictions, HRSA guidance, and payer carve-out requirements; updates internal processes and communicates changes to pharmacy team.

This role description is a general description of the essential job functions. It is not intended to describe all the duties the Business Office Manager may perform.

KEY COMPETENCIES:

• Communication Skills

Effectively and respectably communicate with other individuals, whether it be a colleague, patient, or patient's family member and appropriately enumerate information in a manner easily understood by all parties. We do this to foster a culture of understanding between all parties, especially in complex and difficult situations, to ultimately provide the best care possible to our patients and their families.

• Decision Making

Ability to make the most appropriate decision in a given situation and then taking the next steps to ensure appropriate and timely completion. This requires conflict resolution skills, critical thinking skills, confidence in your ability to make the right decision in most situations. This also includes ability to prioritize your workday appropriately to ensure the most important tasks are completed on time.

• HealthCare Knowledge

Having the drive to keep yourself abreast and up to date on the new breakthroughs in your area of expertise and communicating them to the rest of the team, as appropriate. This also includes keeping up with your licensure and yearly training requirements within your area expertise along with MAHEC's organizational training. Finally, the ability to apply the depth of knowledge maintained and gained through this process in real life scenarios as appropriate.

• Interpersonal Skills

Showing the ability to meet difficult situations with grace, professionalism, and understanding. Within your area of expertise, showing respect and showing empathy where appropriate with your colleagues, patients, and their family at all times, even when its most difficult to do so. This is done, in part, by effective listening, being your authentic self, showing responsibility and dependability, and being patient with others.

• Organizational Values

Adherence to MAHEC's founding principles and incorporating them every day. This includes, among others, having integrity and accountability, reverence for other cultures and equitable practices, ability to manage change, and displaying a clear understanding of organizational dynamics. Doing these things creates a culture where people want to do the best for each other and gives personal ownership towards the goal of helping people in their time of need.

• Problem Solving

Having an analytical mind and ability to work autonomously to solve complex problems that may arise. The wherewithal to think logically through a difficult problem and come to an appropriate resolution for a given issue. This helps to drive continuous improvement by thinking through where we can improve in a novel way. Measures success by understanding where we are currently and where we want to go and then applying those new ideas to affect positive change.

SPECIFIED SKILLS

• COMPUTER
  • Excellent skills in Microsoft Office including Word, Excel, PowerPoint, and database applications required.

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 related field. Knowledge of 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, 8:00 am to 5:00 pm (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 will need to be flexible in order to respond to special work assignments, or evening activities, as requested by the team leader.

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.

MAHEC Talent Management is located at 121 Hendersonville Road, Asheville, NC 28803. 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.

If you are interested in this role, and you have related experience and qualifications, we encourage you to apply or reach out to View email address on click.appcast.io for support in your job search process. You could be the talent we are seeking for this or other opportunities.