Patient Financial Services Specialist - Pharmacy

SHIFT:

Day (United States of America)

Seeking Breakthrough Makers

Children's Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation.

At CHOP, your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric care-and your career.

CHOP does not discriminate on the basis of race, color, sex, national origin, religion, or any other legally protected categories in any employment, training, or vendor decisions or programs. CHOP recognizes the critical importance of a workforce rich in varied backgrounds and experiences and engages in ongoing efforts to achieve that through equally varied and non-discriminatory means.

A Brief Overview

The Patient Financial Services (PFS) Specialist will lead projects and support the leadership team as a Subject Matter Expert in their field. The Specialist will handle complex issues, investigate denials, identify trends, and hold inter-departmental relationships. The Specialist will maintain internal controls, manage specialized functions and work queues and provide support for special projects. The position will have daily tasks assigned to them, dependent on team/department need. The Specialist must maintain the ability to handle requests from multiple sources and manage multiple deadlines.

The position requires a person to act as a troubleshooter and resolve issues as they arise, and/or involve appropriate management personnel as needed. Must be committed to bringing projects to completion timely and identifying trends, root causes and efficiency opportunities. In the pharmacy space, the Specialist will also support complex pharmacy A/R scenarios, including payment posting, credit resolution, and pharmacy-specific collections. This includes navigating PBM (Pharmacy Benefit Managers) and PSAO (Pharmacy Services Administrative Organizations) processes, resolving pharmacy claim rejections, and collaborating closely with clinical and operational pharmacy staff.

Ideal Candidate:

• Experience with pharmacy billing within a revenue cycle and/or retail pharmacy environment.
• Exposure to Epic, specifically Willow Ambulatory, is strongly preferred.
• Demonstrated understanding of pharmacy workflows, claims processing, reimbursement, and revenue cycle operations.

Why This Role Is Exciting

High Visibility, High Impact

Play a key role in optimizing pharmacy revenue by managing payment posting workflows, reconciling credits, and resolving unapplied payments. You'll directly impact cash flow through A/R follow-up and collections while addressing high-volume pharmacy transactions and ensuring accurate reimbursement.

Strategic Collaboration

Partner with PBMs (Pharmacy Benefit Managers), PSAOs (Pharmacy Services Administrative Organizations) , and internal clinical and operational pharmacy teams to resolve claim issues, underpayments, prior authorizations, and NDC (National Drug Code) discrepancies. Leverage insights from pharmacy-specific denial trends to escalate systemic issues and drive process improvements that strengthen financial performance and operational efficiency.

Mission-Driven Work

Your expertise will directly support CHOP's mission to deliver exceptional care to children and families-making a meaningful difference every day.

Growth & Development

CHOP is deeply invested in your growth subject matter expert and leader. Beyond internal leadership development, you will receive a complimentary Healthcare Financial Management Association (HFMA) membership, providing access to nationally recognized certifications and a network of experts at the intersection of finance and technology.

Community & Purpose

Participate in enterprise-wide volunteer opportunities and patient-focused initiatives that allow you to contribute beyond your day-to-day work.

What you will do

• Acts as subject matter expert in their department, manages projects to timely completion, troubleshoots issues and maintains accurate and compliant workflows.
• Holds inter-departmental relationships within PFS and outside of PFS; manages assigned workflows and work queues associated with these relationships and is the primary communicator with the department for any improvement opportunities.
• Monitors work queues assigned as their responsibility, meeting established production and quality standards for the assigned tasks.
• Specific focus is project oriented. Identify trends, training opportunities, denial prevention initiatives and maintaining internal controls for the department.
• Performs workflow analysis, documents workflows, and testing planning in support of departments strategic and operational objectives.
• Stays current on regulations and industry standard trends to ensure CHOP is compliant.
• Responsible for creating presentation and data analytics to drive change and improvements.
• Documents processes to help keep revenue cycle stakeholders informed and identify optimization opportunities.
• Other duties as assigned.

Education Qualifications

• High School Diploma / GED - Required
• Bachelor's Degree - Preferred

Experience Qualifications

• At least three (3) years of work experience in healthcare billing or collections environment or other related role - Required
• Demonstrated success in resolution of patient accounts; demonstrated ability to identify trends and complete assignments timely - Required

Skills and Abilities

• Strong math aptitude (Required proficiency)
• Excellent organizational skills. (Required proficiency)
• Clear and concise decision making skills (Required proficiency)
• Leadership skills (Required proficiency)
• Detail oriented (Required proficiency)
• String interpersonal skills (Required proficiency)
• Excellent writing and oral communication skills (Required proficiency)
• Ability to work independently; results oriented (Required proficiency)
• Ability to handle confidential matters. (Required proficiency)
• Flexibility to work overtime as needed/required (Required proficiency)
• Experience with personal computers including Excel (Required proficiency)
• Experience with Epic system (Preferred proficiency)

To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must receive an annual influenza vaccine. Learn more.

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SALARY RANGE:

$30.25 - $38.55 Hourly

Salary ranges are shown for full-time jobs. If you're working part-time, your pay will be adjusted accordingly.

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At CHOP, we are committed to fair and transparent pay practices. Factors such as skills and experience could result in an offer above the salary range noted in this job posting. Click here for more information regarding CHOP's Compensation and Benefits.