Pharmacy Reimbursement Director

The Pharmacy Reimbursement Director will lead the team responsible for obtaining prior authorization, billing, accepting and managing pharmacy payor claims for specialty and specialty infusion medications.

Essential Duties and Responsibilities

• Develop and implement reimbursement strategies that maximize revenue and ensure timely payment from payers, including private insurance, Medicare, and Medicaid.

• Oversee the management of the prior authorization process, ensuring efficient and effective handling to facilitate patient access to medications.

• Lead and manage the reimbursement team, holding members accountable for their performance while fostering a positive and productive work environment.

• Collaborate with cross-functional teams, including pharmacy operations, clinical services, and patient support, to optimize reimbursement processes and enhance patient care.

• Stay abreast of changes in reimbursement policies and regulations, ensuring compliance and adapting strategies as necessary.

• Utilize knowledge of "Cover My Meds" and other relevant platforms to streamline processes and improve patient access to medications.

• Contribute to the maintenance and enhancement of CSI Pharmacy's culture of service, ensuring that all activities align with our core values and mission.

• Assists management in special assignments, such as market tests and surveys.

• Consistently represents the company in a professional manner.

• Maintains effective working relationships and cooperates with Company personnel.

• Adheres to the Company’s compliance requirements as stated in the policy and procedure manual and all other related policies.

• Adheres to organization policies and procedures.

Qualification Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Provide the highest level of professionalism, responsiveness, and communication in order to build and maintain a high performing team that works together to achieve results.

• Must possess the ability to multi-task and frequently change direction.

Education and/or Experience

• Preferred, but not required, Bachelor’s degree in Healthcare Administration, Business, Pharmacy, or related field.

• At least 5 years of experience in home infusion and/or specialty Pharmacy Reimbursement, PBM specific.

• At least 2 years of management experience, with a proven track record of leading teams to achieve results.

• Specific experience with specialty infusion reimbursement is required.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, climb stairs, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

The employee frequently lifts and/or moves up to 20 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This job generally operates in a clerical office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines. While performing the duties of this position, the employee may travel by automobile and be exposed to changing weather conditions.

Comments

This description is intended to describe the essential job functions, the general supplemental functions, and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities, and requirements of a person so classified. Other functions may be assigned, and management retains the right to add or change the duties at any time.

NOTICE: Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.

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By submitting your application, you are confirming that you are legally authorized to work in the United States.

JR# JR237216