Access & Reimbursement Supervisor

Alivia Health• GUAYNABO, PR, US, PR

About The Position

Under the leadership of the Access & Reimbursement/ Delivery Coordination Manager, the Access & Reimbursement Supervisor is responsible for the day-to-day oversight and performance management of access and reimbursement operations, including insurance eligibility verification, prior authorization processes, and Patient Assistance Program (PAP) activities. This role ensures that all cases are processed accurately, completely, and within established turnaround times. The Supervisor is responsible for ensuring that the team consistently performs at the expected quality and productivity levels.

Requirements

Strong interpersonal communication skills, including team leadership, conflict resolution, collaboration, and the ability to foster a positive and accountable work environment.
Excellent verbal and written communication skills, with the ability to communicate effectively with team members, patients, healthcare providers, payers, and internal stakeholders.
Ability to supervise, coach, develop, and motivate team members while promoting a collaborative, accountable, and high-performing team culture.
Strong organizational, time management, and multitasking skills, with the ability to manage multiple priorities in a fast-paced operational environment.
Results-oriented mindset, with the ability to achieve key performance indicators, productivity standards, quality expectations, and established service levels.
Ability to analyze operational performance metrics, identify trends and improvement opportunities, and implement corrective actions to optimize team performance.
Strong problem-solving, decision-making, and operational issue management skills.
Ability to adapt to changes in processes, priorities, and business needs while effectively leading change implementation within the team.
Strong customer service orientation and commitment to delivering an exceptional experience to patients, healthcare providers, payers, and internal stakeholders.
Ability to collaborate effectively with cross-functional teams to ensure operational continuity, efficiency, and alignment across departments.
Ability to maintain confidentiality and appropriately handle sensitive patient, employee, and business information.
Proficiency in Microsoft Office programs, including Word, Excel, Outlook, PowerPoint, and Teams.
1 to 3 years of experience in similar functions, project management or equivalent experience.

Nice To Haves

Knowledge of CPR+ or similar pharmacy management systems preferred.

Responsibilities

Supervise the daily operations of the Access & Reimbursement and Patient Assistance Program (PAP) teams, ensuring timely, accurate, and complete processing of cases related to PBM benefits, medical benefits, PAP, copay assistance, and other applicable access programs.
Create work schedules, operational plans, and team priorities to ensure appropriate workload distribution, effective queue management, and adherence to established service level and turnaround time expectations.
Ensure accurate case documentation, eligibility evaluation, enrollment management, required documentation, copay information, financial assistance details, and follow-up activities are completed in accordance with payer, PAP, and internal requirements.
Supervise PAP workflows, including applications, patient communications, follow-up activities, and appropriate use of operational platforms and tools, including TailorMed, to support timely access to therapy.
Ensure cases are complete, accurate, and ready for the next steps in the process prior to Delivery Coordination, minimizing rework and supporting continuity of patient access to therapy.
Monitor, analyze, and drive Access & Reimbursement and PAP operational metrics related to productivity, quality, turnaround time, service level performance, and patient experience outcomes.
Supervise, coach, mentor, and develop team members through performance data analysis, ongoing feedback, training support, and accountability for measurable results.
Collaborate with the Education team to identify training needs and coordinate training processes for new and existing team members, ensuring timely completion of required training and continuous competency development.
Generate, review, analyze, and present operational reports, including PBM, payer, PAP, and other performance indicators, to support decision-making, identify trends, manage risks, and drive continuous process improvement.
Collaborate with Delivery Coordination, Pharmacy, Revenue Cycle Management, and other cross-functional teams to ensure efficient transition of approved cases and continuity of patient access to therapy.
Document, manage, escalate patient complaints, service concerns, technical issues, and operational barriers, ensuring appropriate resolution or escalation to the Information Technology department when needed.
Ensure compliance with company policies, procedures, regulatory standards, and payer requirements while promoting a culture of quality, compliance, accountability, and exceptional service.
Support team operations by assisting with claim reversals, list movements, void processes, workflow optimization initiatives, and other Access & Reimbursement-related activities as needed.
Perform other duties as assigned.