3rd Party Operations Supervisor

BrightSpring Health Services•Louisville, KY

4d•Onsite

About The Position

Our Company PharMerica Overview Join our PharMerica team! PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy environment. Our organization is in high growth mode, which means advancement opportunities for individuals who are looking for career progression! Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centers nationwide. If your passion is service excellence and top-quality care come join our team and apply today! The Supervisor, 3rd Party Analysts is responsible for the direction and coordination of the 3rd Party Analyst team as well as the coordination of transactions between PharMerica and 3rd party payers. The supervisor will interact with appropriate departments to provide operational support and ensure integrity of third party plan and claim information.

Requirements

Associate’s degree, relevant technical certification, or equivalent work experience
2+ years experience in a supervisory, managerial, or leadership role
5+ yrs experience working as a Pharmacy Technician, or in a billing potion within a healthcare setting
3+ yrs experience with pharmacy or health data analysis
2+ yrs experience working in a Pharmacy, Long Term Care, or Managed Care setting
Must be a good leader
Ability to maintain confidentiality
Proficiency in MS Office Products (Excel, Word) and basic computer knowledge
Excellent verbal and written communication skills, and C-level presentation skills
Ability to effectively navigate ambiguous situations with limited direction
Able to handle high volume and significant workload
Familiarity with long term care pharmacy or facility billing practices

Nice To Haves

Bachelor’s degree
Specialized understanding of billing requirements for Medicare Part D or Medicaid
AS400 computer system experience

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.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Each essential function is required, although reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions