Senior Manager, Pricing (Pharmacy Reimbursement Appeals)
Core
Lead a team and contractors in managing pharmacy reimbursement appeals, ensuring execution under tight Turnaround Times (TATs) and high accuracy while developing solutions to automate processes and meet state regulatory changes.
Role type
Senior Manager, Pricing (Pharmacy Reimbursement Appeals)
Builds
Automated appeal processes and compliant pricing strategies for pharmacy reimbursement
Domain
Healthcare / Pharmacy Benefit Management (PBM)
Deliverable
client delivery
Required skills
Strategic leadership, claims adjudication logic, state regulatory compliance, process improvement, cross-functional collaboration, team coaching, profitability analysis, market competitiveness analysis, pricing policy development, quality control
Preferred skills
Excel, MS Access, Salesforce, Pharmacy Portal, mathematical problem-solving, wholesaler invoice analysis
Technologies
Excel, MS Access, Salesforce, Pharmacy Portal
Responsibilities
Lead appeals teams to ensure effective pricing strategies and operations; Analyze competitive insights to generate actionable recommendations; Collaborate with legal, finance, and account teams to align pricing strategies; Influence stakeholders to establish mutually beneficial partnerships; Counsel and mentor pricing team members; Deliver pricing solutions that drive profitability and revenue optimization
Seniority
Senior, hands-on IC with team leadership