Patient Financial Services Specialist - Pharmacy
Children's Hospital of PhiladelphiaAbout the role
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 or
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