Systems & Integration Manager

Independent Health•Buffalo, NY

9d•$70,000 - $90,000•Hybrid

About The Position

The Systems and Integration Manager will be responsible for the overall management, optimization, and continuous improvement of the pharmacy management system, third party integrations, and related technology platforms supporting specialty pharmacy operations. This role will serve as the primary liaison between pharmacy operations, IT, billing/reimbursement, vendors, and system third party vendors to ensure technology solutions effectively support business needs, regulatory requirements, workflow efficiency, and patient service. The Systems and Integration Manager will lead system configuration, workflow development, automation, electronic data interchange (EDI), Open Refill File Transfer “ORTF” configuration, acceptance, and delivery, 835/payment file implementation, enhancement requests, issue resolution, and system-related projects. The role will identify opportunities to improve processes through technology with high ROI, while maintaining system integrity, data accuracy, compliance, and operational efficiency.

Requirements

Bachelor’s degree required. An additional four (4) years of experience will be considered in lieu of degree.
Five (5) years of experience working in specialty pharmacy, healthcare IT, or with pharmacy management systems required.
Understanding of pharmacy claims, billing, reimbursement, and payor processes.
Strong understanding of specialty pharmacy workflows.
Experience with system testing, workflow development, automation and implementation.
Strong project and program management and organizational skills.
Ability to work effectively with both technical and non-technical teams.
Strong Microsoft Office skills required.
Excellent verbal, written and interpersonal communication skills.
Proven examples of displaying the Reliance values: Collaborative, Accessible, Results-Oriented, Empowering, and Supportive.

Nice To Haves

Experience configuring or administering pharmacy software is strongly preferred.
Experience with EDI transactions and 835 files preferred.
experience with ScriptMed preferred.

Responsibilities

Serve as the primary business owner and subject-matter expert for the pharmacy management system.
Maintain system configuration, workflows, business rules, protocols, queues, and user functionality.
Evaluate system capabilities and identify opportunities to improve efficiency, accuracy, and scalability.
Maintain system documentation, workflows, configuration specifications, and change history.
Partner with IT and software vendors on system upgrades, releases, testing, and issue resolution.
Manage and oversee the organization's transition to NCPDP F6 pharmacy claims standards, including requirements gathering, system configuration, testing, vendor coordination, implementation, and ongoing pharmacy claims management support to ensure compliant and efficient claims processing.
Develop and enforce standardized procedures for user provisioning, role assignment, access reviews, and termination workflows to ensure appropriate system access and data security.
Oversee periodic audits and validation of user permissions, ensuring access remains aligned with job responsibilities and compliance requirements.
Collaborate with Compliance, Information Security, and business stakeholders to define and maintain role-based access controls and system security standards.
Design and implement automation solutions, alerts, and workflow enhancements that improve operational efficiency and scalability.
Analyze existing workflows to identify opportunities for automation and standardization.
Monitor automation performance and adjust as business needs change.
Own the pharmacy system support-ticket process and serve as the escalation point for system-related issues.
Prioritize, investigate, and coordinate resolution of system issues with internal IT teams and external vendors.
Track recurring issues and identify root causes and opportunities for permanent solutions.
Establish appropriate escalation and communication processes for critical system issues.
Monitor ticket trends and use data to identify opportunities for system improvements.
Manage system enhancement requests from initial requirements through implementation.
Serve as the liaison between pharmacy operations and technical teams, translating business requirements into system solutions and enhancement opportunities.
Develop project plans, timelines, testing requirements, and implementation plans.
Assess the operational impact of system changes and coordinate training and communication.
Coordinate the implementation, configuration, testing, and maintenance of EDI transactions between the pharmacy and external partners.
Partner with payers, clearing houses, vendors, billing, finance, and IT to resolve EDI and transaction issues.
Manage setup and troubleshooting of 835 Electronic Remittance Advice (ERA) files and related payment/reconciliation processes.
Accountable for the design, configuration, implementation, testing, and ongoing support of 837 electronic claim transactions (837P, 837I, and applicable specialty pharmacy medical billing formats) to ensure accurate and compliant claim submission to payers.
Support implementation and maintenance of other electronic transactions as applicable, including eligibility, claims, acknowledgments, and remittance transactions.
Validate transaction mapping and ensure data is accurately transmitted between systems.
Troubleshoot rejected, missing, or incorrectly formatted transactions and coordinate resolution with appropriate parties.
Act as the bridge between pharmacy operations and technical teams.
Communicate technical issues and solutions in a way that is understandable to non-technical stakeholders.
Develop test plans and scenarios for system changes and enhancements.
Conduct or coordinate regression testing following system updates.
Ensure system changes support applicable pharmacy, payer, HIPAA, security, and regulatory requirements.
Coordinate implementation and post-implementation monitoring.
Coordinate user acceptance testing (UAT) and validate system functionality before production implementation.