Sr. Manager, Pricing - Pharmacy Appeals
Core
Lead a team and contractors in managing pharmacy reimbursement appeals, including the Service Warranty process and Secondary Appeals operations, ensuring execution under tight Turnaround Times (TATs) and high accuracy.
Role type
Senior Manager, Operations & Pricing
Builds
Pharmacy appeals service warranty process and Secondary Appeals operations
Domain
Healthcare / Pharmacy Benefit Management (PBM)
Deliverable
client delivery
Required skills
Pharmacy claims and appeals knowledge, State regulatory compliance, Claims adjudication logic, Team leadership, Process improvement, Analytics, Strategic decision-making
Preferred skills
Excel, MS Access, Salesforce, Pharmacy Portal, Mathematical problem-solving, Wholesaler invoice analysis
Technologies
Excel, MS Access, Salesforce, Pharmacy Portal
Responsibilities
Lead strategic guidance for pharmacy reimbursement appeals teams to improve performance; Oversee pharmacy appeals service warranty process for timely processing; Review and respond to complex inquiries from state regulators and pharmacies; Analyze market trends and competitive insights for recommendations; Collaborate cross-functionally with legal, finance, and account teams; Counsel and mentor team members to enhance skills.
Seniority
Senior, hands-on IC with team leadership