Manager, Payer Strategies - Specialty Pharmacy
About The Position
Join our innovative team at Optime Care as a Manager, Payer Strategies, where you'll make a meaningful difference in the lives of patients facing complex, chronic conditions and rare diseases. In this exciting role, you'll have the opportunity to manage key aspects of Optime Care’s strategies, activities, and relationships between potential clients, current clients, internal team members, and the payer community, as well as being a resource for physician offices. This position will manage our Insurance Coordinators, who support the Care Teams and our patients with specific insurance questions and information. This role will be hybrid, based at our Optime Care Office in Earth City, MO, and will be required to be in the office a minimum of 3 days a week. Join Optime Care - Where Innovation Meets Patient Care
Requirements
- Knowledge of Medicare and Medicaid billing
- Experience with prior authorization and SMN preparation
- Knowledge of claim appeals
- Medical terminology required
- Knowledge of medical/pharmacy insurance benefit language; ie. EOB’s, deductibles, Out of pocket, co-insurance, co-pays, etc.
- Exceptional communication and leadership skills; able to balance empathy with accountability while navigating many different personalities.
- Strong oral and written communication skills.
- Excellent leadership skills and the ability to navigate different personalities.
- Strong attention to detail, process-oriented, excellent organizational skills, and adherence to deadlines.
- Ability to work and adapt in a complex, dynamic organization.
- Must be able to effectively multitask and work in a fast-paced environment with the ability to prioritize competing tasks.
- Ability to manage time-sensitive documents.
- Ability to work independently, as well as in a team environment.
- Interact effectively and productively with colleagues and business partners.
- Proactive and communicative, knows when to escalate.
- An innovative thinker willing to bring forth ideas to enhance processes.
- Proficiency in Microsoft Office Suite, specifically Excel, Word, PowerPoint, and Outlook.
- Excellent presentation skills.
- Five (5) or more years of progressive experience in specialty pharmacy and the orphan drugs market.
- Previous experience in insurance and payer markets related to prescription plans, claims, and rebates.
Nice To Haves
- Patient Assistance Program knowledge a plus
Responsibilities
- Collaborate with Senior Leadership to support planning, development, and implementation of strategies to support communication with potential and current clients related to payers
- Support planning and development of strategies to support payer activities internally
- Collaborate with Licensing and Payer Specialist to negotiate and validate reimbursement rates for each drug on behalf of Optime Care and the client at the lowest possible discount
- Support Care Teams in gaining insurance coverage for prescribed therapies
- Complete and submit applications for contracting for health plans, PBMs, and wholesale licenses
- Communicate terms of contracts to the team, ensure timely delivery of PBM/Health Plan required reports
- Support functions of Finance and Quality teams
- Support Care Coordinators and/or Finance in achieving correct reimbursement rates from payers
- Train new personnel on PBM and Health Plan contracting as it relates to their role
- Serve as a resource for all team members
- Perform other related duties as assigned or necessary; remain flexible and adaptable in work schedules and assignments as defined by departmental and organizational needs.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
