Senior Manager, Pharmacy Revenue Cycle Management

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November 21

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SelectQuote Insurance Services

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Healthcare Insurance • Finance • B2C

SelectQuote Insurance Services is a leading term life insurance sales agency that also provides auto, home, and Medicare insurance. Customers can save on life insurance without the need for a medical exam, offering budget-friendly, fully underwritten rates. The company is known for its hassle-free process of shopping and comparing insurance options from highly rated carriers, allowing customers to find the best rates available. SelectQuote acts as a convenient one-stop shop for various insurance needs and offers free, unbiased quotes with the help of experienced licensed insurance agents.

1001 - 5000 employees

Founded 1985

⚕️ Healthcare Insurance

💸 Finance

👥 B2C

📋 Description

• Develop and implement strategic plans for the end-to-end pharmacy revenue cycle to maximize clean claim submission and net revenue. • Oversee billing and collections for complex pharmacy claims, including prior authorizations, and complex payer requirements (e.g., Medicare Part D, Medicaid, commercial plans). • Analyze and report on key performance indicators (KPIs) such as Days in Accounts Receivable (A/R), denial rates, adjustment reasons, and collection percentages, presenting findings and recommendations to senior leadership. • Manage relationships with external payers and vendors related to billing systems, claims processing, and denial management. • Develop, manage, and adhere to the department's operating budget. • Lead and continuously improve all revenue cycle operations, including charge capture, claims submission, payment posting, denial management, and appeals. • Identify root causes of denials and underpayments, leading cross-functional initiatives with Pharmacy Operations, Finance, and IT teams to implement effective solutions. • Ensure timely and accurate reporting for all financial and operational metrics. • Drive the evaluation and implementation of new technologies, automation, and AI tools to enhance revenue cycle efficiency. • Assist with internal and external audits related to pharmacy billing and compliance, developing and executing corrective action plans as needed. • Responsible for auditing PBM payments against contractual rates and reporting on compliance to maximize revenue realization. • Lead, mentor, and empower a team of supervisors and billing specialists. Establish clear performance goals, conduct regular performance reviews, and provide specialized coaching to drive team excellence. • Collaborate closely with Finance and Accounting on payment application reconciliation and financial reporting.

🎯 Requirements

• Bachelor’s degree in Accounting, Finance, Healthcare Administration, Business, or relevant experience • Minimum of 7+ years of progressive experience in Healthcare Revenue Cycle Management, with at least 5 years in a leadership role overseeing large or complex teams required • Master’s Degree (MBA, MHA) or relevant professional certification (e.g., CPA, CHFP, CRCR) preferred • Experience with pharmacy management & billing platforms preferred

🏖️ Benefits

• Competitive Medical, Dental, and Vision insurance • HSA/FSA • Voluntary Hospital Indemnity, Critical Illness, accident insurance, and short term disability • Voluntary Life Insurance for self, spouse and dependent • Company-paid Basic Life Insurance and Long Term Disability • Retirement plan and employer match contribution with Profit Share • Tuition Reimbursement program • Company perks and discount program • Engaging Wellness and financial education resources • Employee Assistance Program • Incentive Plans