Manager of Mac and Process Development

Maxor National Pharmacy Services, LLC-posted 2 months ago

Full-time • Manager

Plano, TX

501-1,000 employees

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The Manager of MAC and Process Development is responsible for Maximum Allowable Cost(MAC) / network pricing strategy as well as the execution, implementation, and optimization of current, new, and future MAC / pricing innovation. Will lead complex financial modeling and process development to create business insight, quality assurance, and execution to achieve departmental goals. In partnership with other team leaders and members, develop reimbursement strategy, execute on network pricing, create standard and customized pharmacy network reports, and oversee client / pharmacy analytics including network disruption, geo-access reporting, and Network compliance including NCPDP validation. Develop capabilities specifically targeted to achieve the efficient and effective application of the company’s products and services toward the achievement of total cost savings and improved health outcomes for the company’s clients and their members.

Develop business, industry, competitive, client, and technical knowledge to formulate pricing strategy, and to execute financial modeling of comprehensive pricing strategies
Consult with internal leaders and departments to coordinate relevant cross functional activities in support of network performance management efforts to maximize the organization’s competitive position
Execute and implement dynamic pricing strategies in response to market fluctuations to provide competitive, profitable, and best of class pricing offers
Collaborate with the Underwriting team to provide recommendations on pricing and negotiation strategy to achieve revenue, support re-pricing process, profitability targets, and margin retention, for new and existing customers
Support VytlOne consulting opportunities related to MAC / Network pricing including, but not limited to: generating financial models to reprice claims and calculate MAC pricing, provide insights on proposals, assist in implementation strategies
Build process to validate data transmissions for accurate adherence to our rate guidelines and MAC prices
Establish, maintain, and adjust as necessary a MAC pricing algorithm in coordination with company strategy, contractual financial obligations, market conditions, and adherence to state MAC laws
Develop understanding of claim adjudication pricing parameters and lead process development to automate network / MAC builds and pricing adjustments while incorporating QA validation
Oversee the MAC Appeals process ensuring proper intake and response to all appeals in accordance with applicable MAC Appeal laws
Develop and maintain MAC reference file to track and support MAC setups inquiries
Provide Pharmacy Audit support and develop a process to track Audit findings and coordinate those findings with Finance
Build and maintain claim re-pricing process that forecasts Pharmacy, Client, and Member pricing impact
Coordinate with VytlOne Rebate team in process review / development in effort to optimize rebate pricing strategies
Identify gaps in current processes and provide / implement recommendation to streamline efficiencies and quality
Assist in the creation and support of a process to intake, catalog, and respond to Network Disruption and Access requests
Provide as needed support and training for process development tools (such as Alteryx) – as well as support of automation implementation strategies - to bolster VytlOne's automation efforts
Promptly report any allegations of impropriety to the Compliance Department
Comply with Maxor’s Ethical Business Conduct policy and Maxor’s Compliance Program
Remain free from exclusion under the OIG and SAMS Medicare/Medicaid lists
Complete required training, as assigned, within the established timeframes
Must be able to cope with the mental and emotional stress of the position
Ensure staff is informed of product upgrades or enhancements in a timely manner
Hire and train competent staff
On a biweekly basis, verify departmental timesheets for departmental employees ensuring the timesheets are accurate based on the work-schedule and necessary corrections are done prior to timely Payroll submission
Develop and mentor departmental staff by providing career coaching; motivate departmental staff, individually and as a group; understand and support diversity; and establish an effective team
Conduct initial and annual performance evaluations
Promote teamwork; discipline staff when warranted

Bachelor’s Degree in Finance, Accounting, Math, Business, Computer Science, or related area of study
Experience in Analytics including large data sets, MAC modeling, and process automation. Preferred experience in a PBM setting
Excellent management and planning skills, detail oriented
Strong analytical and problem solving skills
Ability to organize and manage multiple priority tasks simultaneously
Proven and demonstrated project management skills, directing project activities to a cross-functional team
Problem solving ability in unstructured situations
Ability to lead effective meetings, accomplish goals and meet timelines
Ability to work well in cross-functional situations, giving clear direction and partnering with other internal departments to reach common goals
Ability to manage, mentor, and develop team members with expertise on MAC pricing and the adjudication systems with particular emphasis on developing processes that are both accurate and efficient
Experience influencing change and adoption of new analytic capabilities to support pricing financial analytics
Experienced user of two or more of the following: SQL, SAS, Alteryx, Tableau, Power BI, R, or Python technologies

Comprehensive mental health and wellbeing resources
Nationwide Blue Cross Blue Shield PPO with employee-friendly plan design, including a $850 individual annual medical deductible and $25 office visit copays, with low biweekly premiums
Company-paid basic life/AD&D, short-term and long-term disability insurance
Rx, dental, vision, other voluntary benefits, and FSA
Employer-matched 401k Plan
Industry-leading PTO plan

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