ACCESS & REIMBURSEMENT- PBM MANAGER

Under the leadership of the Senior Manager the main objective of this role is to provide ongoing oversight of the Access & Reimbursement. This team is accountable for managing Pharmacy benefit (PBM). The team will work with coverage eligibility, submit claims, follow up with plan to obtain pre authorization and obtain information and documents required for evaluation. The Manager will manage all aspects of the department functions, including personnel, systems, initial and ongoing training, and employee development.

Responsibilities include but are not limited to:

• Holds self and others accountable for measurable high quality and timely.
• Ensure accurate and timely documentation by all employees providing access services (e.g Perform insurance eligibility for patients, facilitate process for requesting Prior Authorizations, etc.)
• Develops/refines processes and procedures and ensures they are consistently applied across the Access & Reimbursement Department.
• Leads Change – acts as a catalyst for organizational change and employee engagement.
• Makes decisions that produce high quality results by applying technical knowledge, analyzing problems, and calculating risks.
• Evaluates and reduces through training & development performance issues & error that may generate or not service or reimbursement issues.
• Partners with the Medical Claims Department & PAP & Other operational teams when necessary. (e.g. Financial Assistance, etc.)
• Assesses and analyses team performance, identifies performance gaps and provides feedback and coaching.
• Responsible for leading a team through teaching, coaching and inspiring by fostering a sense of energy, ownership, and a responsibility for the flawless execution of commercial excellence; engage in the selection and hiring process as needed.
• Administers company personnel policies and follows company staffing standards.
• Enforcing policies and procedures to include business standards, maintaining customer satisfaction levels, and improving quality of service.
• Collaborates with key business partners on process and or operational improvements to enhance efficiency and effectiveness of Access & Reimbursement Department.
• Monitoring and assessing staff’s compliance with the Company’s rules and procedures related to behavior with Patients and Co-workers, attendance, dress code, productivity standards and any other applicable instruction provided by Company’s management.

Minimum Requirements:

• 2 years of leadership/people management experience is required.
• Prior experience working in health plan.
• Demonstrated track record of meeting/exceeding goals.
• Skilled at building relationships (e.g. Payers)
• Prior experience working in Specialty Pharmacy preferred.
• Knowledge of Access and Reimbursement matters is preferred.
• Pharmacy Technician Associate Degree -Pharmacy license and registration
• Bachelor’s degree in healthcare or business-related field (preferred)

***EEOC F/M/D/V***