3rd Party Operations Supervisor

Responsibilities

• Works in conjunction with the 3rd Party Operations Manager to establish analyst level goals, department wide goals, performance tracking and quality assurance metrics
• Clearly communicates roles and responsibilities of analysts and provides guidance and leadership to staff
• Establishes and maintains professional and effective relationships with staff, peers, payers, and other stakeholders
• Serves as a liaison with staff and payers or internal departments to coordinate and troubleshoot various claim, payer, or other industry related issues
• Works to update, or create and maintain Standard Operations Procedures for the department, including clearly outlining training plans for new or underperforming analysts
• Ensures team assignments are fair and balanced based on analyst’s skills sets
• Manages staff attendance and time sheets for payroll (Day Force) system. Assures staff is meeting attendance policies and reports any variations to Manager
• Holds regularly scheduled meetings with staff to discuss performance metrics and ensure employees are on track to meet their goals
• Enforces disciplinary action and creates performance improvement plans as needed for underperforming staff
• Create and manage reporting opportunities to mitigate third party rejections, reduce revenue loss, and implement process improvements
• Stays up to date on third-party billing requirements and reimbursement guidelines
• Serves as a Subject Matter Expert (SME) for the organization on internal claims billing system and industry relations
• Participates in meetings of the National Council for Prescription Drug Programs (NCPDP), representing the interests of PharMerica and the long term care pharmacy perspective
• Collaborates regularly with Contracting, Purchasing, Claims Processing, Accounts Receivable, Cash Processing, Facility Billing, Admissions, Census, Plan Administration, IT, and other areas of the company
• Ensures communications impacting other areas of the company are distributed properly and timely
• Performs other tasks as assigned
• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.

Qualifications

Education/Learning Experience

• Required: Associate’s degree, relevant technical certification, or equivalent work experience
• Desired: Bachelor’s degree

Work Experience

• Required: 2+ years experience in a supervisory, managerial, or leadership role
• Required: 5+ yrs experience working as a Pharmacy Technician, or in a billing position within a healthcare setting
• Required: 3+ yrs experience with pharmacy or health data analysis
• Required: 2+ yrs experience working in a Pharmacy, Long Term Care, or Managed Care setting
• Desired: Specialized understanding of billing requirements for Medicare Part D or Medicaid

Skills/Knowledge

• Required: Must be a good leader
• Required: Ability to maintain confidentiality
• Required: Proficiency in MS Office Products (Excel, Word) and basic computer knowledge
• Required: Excellent verbal and written communication skills, and C-level presentation skills
• Required: Ability to effectively navigate ambiguous situations with limited direction
• Required: Able to handle high volume and significant workload
• Required: Familiarity with long term care pharmacy or facility billing practices
• Desired: AS400 computer system experience