Manager Third Party Operations; Help Desk and TP Systems

Job Title: Manager, Third Party Help Desk & Systems

Reports to: Director, Managed Care Operations

Department: Managed Care Operations Third Party Help Desk & Systems

Job Responsibility:

• Project Management for Third Party Operations Systems enhancements, Third Party Help Desk Improvements and Third Party cross-functional support
• Manages IT Support Desk Relationship and support ticket ownership
• Responsible for Third Party Operational procedures posted on Daily Dose
• Direct oversight of Third Party Help Desk call center, reporting, process improvement and support for scheduling and staffing.
• Point person with Managed Care teams and outside departments on reports, edits, training, and various other tasks
• Manage relationship and communications with vendors
• Ensure all pharmacies can process through switch vendor and elevate necessary outages
• Review work of direct reports to ensure accuracy and provide feedback
• Responsible for reviewing department processes to ensure maximum efficiency in all required tasks
• Provide reports and updates to Management regarding staff’s individual and team performance
• Proactively identify potential editing opportunities to maximize margin/minimize loss via vendor processing system reporting
• Identify potential vendor processing system enhancements to assist with reporting capabilities
• Confirm reimbursement based on contracted rates and follow up with PBM/Plan contacts when noncompliance is identified
• Review and identify legal and audit risks that may occur based on vendor system reporting available
• Communicate effectively, including very detailed follow-up, with all areas of the business, vendors, and PBM/Plan contacts
• Identify, create, and manage editing to ensure pharmacy compliance with PBM requirements to prevent future audit recoupments

Education/

Experience:

• H.S. Diploma
• Pharmacy Technician preferred
• Third Party/Managed Care experience preferred
• Management or Training experience preferred
• Helpdesk experience preferred

Skills/Knowledge Requirement
:

• Advanced computer skills – Microsoft Office (Excel, Access, Outlook etc.)
• Ability to work in a team environment and adapt easily to constant change
• Math skills at a proficient level
• Strong communication skills, both written and verbal
• Ability to manage time efficiently and stay organized
• Ability to follow verbal or written instruction
• Strong decision-making abilities
• Detail oriented
• Knowledge of third party processing and NCPDP industry standards preferred

Physical Environment:

• Most work is performed in a temperature-controlled office environment
• Incumbent may sit for long periods of time at desk or computer terminal
• Incumbent may use calculators, keyboards, telephone, and other office equipment during normal workday