Manager – Pharmacy Revenue Operations

Position Description

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more. 

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”

This role is responsible for the strategic leadership, oversight, and continuous improvement of pharmacy financial processes and tracking. This role ensures the accurate administration, reconciliation, accrual, reporting, allocation, and disbursement of pharmacy manufacturer rebates and network rate guarantees across commercial, Medicare, and self-funded lines of business. -The Manager serves as the primary liaison between Pharmacy all relevant areas of the business - including Finance, Accounting, Actuarial, Information Technology, Underwriting, and the Pharmacy Benefit Manager (PBM) to ensure rebate processes are compliant, auditable, financially accurate, and aligned with contractual and regulatory requirements. This position plays a critical role in supporting financial reporting, rebate transparency initiatives, and evolving regulatory requirements.

Responsibilities and Qualifications

Rebate Operations Leadership

• Lead end-to-end pharmacy rebate operational oversight including receipt, validation, allocation, reconciliation, reporting, and financial settlement of manufacturer rebate payments.
• Oversee operational workflows supporting quarterly and monthly rebate processing activities.
• Ensure rebate data integrity across pharmacy, finance, and accounting systems.
• Monitor operational performance and develop process improvements to increase efficiency, scalability, and audit readiness.
• Collaborate with PBM partners to resolve rebate discrepancies, operational issues, and data quality concerns.

Accounting and Financial Management

• Continual review of rebate accounting activities including accrual development, journal entries, financial reporting, and reconciliation processes.
• Partner with Finance and Actuarial teams to develop and validate rebate projections and accrual methodologies.
• Ensure accurate recording of rebate revenue and appropriate allocation across products, groups, and lines of business.
• Monitor rebate balances, variances, and trends while identifying and resolving financial discrepancies.
• Support month-end, quarter-end, and year-end financial close activities related to pharmacy rebates.

Compliance, Audit, and Controls

• Maintain strong internal controls governing pharmacy rebate processes and financial transactions.
• Assist with responses to internal and external audits involving pharmacy rebates, financial reporting, and contractual compliance.
• Ensure adherence to accounting standards, regulatory requirements, and organizational policies.
• Develop and maintain process documentation, controls, and standard operating procedures.
• Establish monitoring and reporting mechanisms to support rebate transparency and audit requirements.

Regulatory and Strategic Initiatives

• Assess operational impacts of emerging pharmacy regulations and PBM transparency requirements.
• Lead implementation efforts supporting rebate pass-through models, reporting obligations, and audit provisions associated with CAA 2026 and other regulatory mandates.
• Participate in cross-functional strategic initiatives involving pharmacy economics, pricing models, and revenue optimization.
• Provide subject matter expertise regarding rebate contracting, administration fees, and financial implications.

Reporting and Analytics

• Support development of dashboards, performance metrics, and executive reporting related to rebate performance and financial outcomes.
• Analyze rebate trends, utilization patterns, contract performance, and financial impacts.
• Present results and recommendations to leadership.
• Support underwriting, pricing, finance, and pharmacy strategy initiatives through data-driven analysis.

Leadership and Talent Management

• Direct, coach, and develop team members responsible for rebate administration, accounting, reconciliation, and reporting activities.
• Foster a culture of accountability, operational excellence, collaboration, and continuous improvement.
• Establish individual and team performance goals aligned with organizational priorities.
• Ensure appropriate succession planning and workforce development strategies are in place.

Skills

• Strong analytical and financial management capabilities.
• Advanced problem-solving and process improvement skills.
• Ability to translate complex financial data into actionable business insights.
• Excellent communication and presentation skills.
• Strong project management and organizational capabilities.
• Proficiency with Excel, Power BI, Tableau, financial systems, and large healthcare data sets.

Knowledge

• Strong understanding of PBM rebate structures, manufacturer contracting, and pharmaceutical economics.
• Knowledge of healthcare accounting principles, accrual methodologies, and financial controls.
• Understanding of Medicare Part D and commercial pharmacy benefit programs.
• Knowledge of healthcare regulatory requirements impacting pharmacy rebate administration.
• Familiarity with audit, compliance, and internal control frameworks.

Experience

• Minimum 7 years of progressive experience in pharmacy benefit management, healthcare finance, accounting, or rebate operations.
• Minimum 3 years of leadership experience managing staff and operational processes.
• Experience with pharmacy manufacturer rebates, PBM financial arrangements, or healthcare revenue management.
• Experience working cross-functionally with Finance, Actuarial, Underwriting, and Pharmacy teams

Education, Certification, and Licenses

• Bachelor's degree in Accounting, Finance, Actuarial Science, Business Administration, Healthcare Administration, Pharmacy Administration, or related field.
• MBA or advanced degree preferred.

Location: 

• This position is classified hybrid, which requires onsite work on Tuesdays and Wednesdays in Harrisburg, PA.

About Us

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues, and be encouraged to volunteer in your community.  We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.     And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.

Compensation: 102310 to 190015 (USD)