Based on our rapid growth, we are expanding our operations team at an exciting time in our history.
EpiphanyRx is looking for a person with a passion for helping plan sponsors control the cost of drugs through an aligned business model, value-based coverage, data-driven solutions, and innovative technologies.
Given our continued growth trajectory, we are looking for a person who can grow with the company’s core operations and lead the expanding team.
The ideal candidate will reside in Nashville, TN.
Job Overview : The Manager of Eligibility and Accumulator Operations is responsible for the day to day accumulator and eligibility operations for a pharmacy benefits management (PBM) organization.
Accountable for executing plans and overcoming operational challenges that impact the performance and results of the team.
Above all else, the Manager of Eligibility and Accumulator Operations is responsible for timely and accurate set-up, receipt, loading and sending of eligibility and accumulator files and corresponding client satisfaction.
Responsibilities and Duties :
· Manage eligibility and accumulator operations activities, and the teams supporting those functions including set-up, on-going operations, QA/Audit and troubleshooting and any other activities related to eligibility and accumulator operations
· Assumes responsibility for accuracy, timeliness and efficiency of eligibility and accumulator operations
· Develops and maintains auditing and reporting for file accuracy and turnaround times.
Monitors reported activities and performance against standards on a weekly basis, and institutes corrective action when established targets are not being met
· Develops, implements, and updates policies and procedures for all eligibility and accumulator activities
· Identifies and reports data processing/information system needs and suggests potential system enhancements or other solutions
· Leads problem solving and prioritizing sessions relating to file and/or systems issues
· Validates implementation through production validation testing
· Recommends and initiates various personnel actions including but not limited to hiring, performance appraisals, disciplinary actions, and promotions
· Make work assignments and review and edit work of direct reports.
Ensures staff members are adequately trained and are competent to perform all required job tasks
· Supervises daily operations for a team of employees
· Works with Implementation Manager to insure the correctness of system configuration for client setup
· Researches and analyzes complex eligibility and accumulator issues to determine root cause and prepares plans for remediation.
· Identifies areas that are at high risk for error and coordinates the implementation of corrective and preventative processes and procedures Minimum Qualifications
· Bachelor’s degree and a minimum of five years of experience in a health care field.
Two (2) of which in a defined leadership role.
In lieu of degree, minimum of Nine (9) years progressive experience in a health care field
· Expertise in eligibility and accumulator processing within healthcare
· Demonstrated leadership skills
· Demonstrated skills in forming and fostering high-performing, cross-functional teams
· Excellent written and oral communication skills, adaptable for all levels of management
· Demonstrated knowledge and experience in the overall health care industry
· Proficient at identifying root causes of business and/or workflow problems and determining innovative solutions and opportunities
· Ability to organize, prioritize, and manage multiple initiatives with effective and accurate results
· Ability to translate business needs and processes into clear and concise procedural documentation
· A working knowledge of Microsoft Office applications is required.
SQL skills are a plus
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