Program Manager, Pharmacy Revenue Compliance

About City of Hope,
City of Hope's mission is to make hope a reality for all touched by cancer and diabetes. Founded in 1913, City of Hope has grown into one of the largest and most advanced cancer research and treatment organizations in the U.S., and one of the leading research centers for diabetes and other life-threatening illnesses. City of Hope research has been the basis for numerous breakthrough cancer medicines, as well as human synthetic insulin and monoclonal antibodies. With an independent, National Cancer Institute-designated comprehensive cancer center that is ranked top 5 in the nation for cancer care by U.S. News & World Report at its core, City of Hope’s uniquely integrated model spans cancer care, research and development, academics and training, and a broad philanthropy program that powers its work. City of Hope’s growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and cancer treatment centers and outpatient facilities in the Atlanta, Chicago and Phoenix areas.

The Pharmacy Revenue Compliance Program Manager plays a critical role in ensuring accurate and compliant pharmacy charge submissions across various internal and external stakeholders. This position oversees pharmacy-related queues, dashboards, and reports to monitor billing accuracy and timeliness within the Electronic Medical Record (EMR), particularly EPIC systems including Willow and Hospital Billing. The manager collaborates with Epic teams to resolve charge-related issues, contributes to medication charge build and mapping, and audits billing activities such as high-cost medications, $0 charges, and waste billing. Familiarity with J Codes, AWP, WAC, NTAP, and billing modifiers (e.g., JW/JZ) is essential, along with maintaining quarterly updates and staying current on payer regulations. The role involves close coordination with departments like Pharmacy Operations, Revenue Cycle, Financial Services, Nursing, and Compliance, and requires navigating resources such as CMS, Red Book, and coding guides to support accurate and timely charge capture in alignment with organizational policies.

The successful candidate:

• Review Epic work queues and reports to ensure billing accuracy (e.g., billing errors, high-dollar, $0 charge queues).

• Troubleshoot and correct billing errors in Epic Willow and Hospital Billing systems.

• Investigate root causes of billing issues to drive process improvements.

• Collaborate with pharmacists, nurses, and providers to resolve billing discrepancies.

• Audit and correct medication waste claims; ensure proper use of JW/JZ modifiers.

• Track and report waste metrics; coordinate with operations on waste changes due to drug shortages.

• Monitor IPS/One Step Med reports for surgical and other clinical areas.

• Submit and validate charge build requirements for new drug entries in Epic Willow.

• Conduct regular audits of charge builds for accuracy.

• Investigate issues such as missing charges, incorrect amounts, and barcode scanning errors.

• Partner with Revenue Integrity on quarterly JCode and waste updates.

• Collaborate with Compliance, Legal, and other stakeholders on internal and external audits.

• Analyze retrospective claims and data to identify billing errors and denial trends.

• Adhere to City of Hope policies, procedures, and compliance standards.

• Maintain confidentiality and demonstrate high integrity.

• Perform additional duties as assigned.

Qualifications

Your qualifications should include:

• Graduate of ACPE-accredited Pharmacy School or an equivalent
  combination of education and experience

• Current Pharmacist License

• Minimum Experience: 3 years in good standing working as a health system pharmacist

• Remote work. Travel may be required for on-site visits related to
  audits or other business purposes

City of Hope is an equal opportunity employer.

To learn more about our comprehensive benefits, click here: Benefits Information

City of Hope employees pay is based on the following criteria:  work experience, qualifications, and work location.