We are looking for an experienced Program Manager to lead a reimbursement hub program and team. This person needs to have a professional manner and be a self-starter. Interaction with senior leval client contacts, handling of escalated issues, staff mentoring, training, report analysis, and in-depth experience with pharmacy and medical reimbursement benefits and biopharmaceutical product access processes required.
|CATEGORY:||Client support and Staff management|
|TYPE:||Exempt, Salaried, Full Time|
|JOB NATURE:||Office based: Oversee operation of call center-based customer service programs.|
|JOB SUMMARY:||Oversight of all staff and activity of the reimbursement hub program to which the employee is assigned. Includes day-to-day operations interaction wit Director/Executive level client contacts. Resolution of escalated cases/issues.|
|JOB DUTIES:||Act as primary point of contact for Director/Executive level client contacts. Manage day-to-day activity of the hub program(s) to which the employee is assigned. Prepare client facing and internal reports, as required. Review and provide guidance for denied or underpaid insurance claims.
Draft program SOPs, work instructions and business rules, in accordance with program contracted SOW.
Develop, implement and train direct reports on program specific Standard Operating Procedures (SOPs) and related processes.
Ensure documentation of all activities in program database within required timelines.
Research, monitor and update payer prior authorization requirements and coverage policies for specified client program.
Provide on-going performance feedback to all direct reports, as required.
Complete probationary, periodic and annual reviews for direct reports.
Provide coaching, mentoring and implement Performance Improvement Plans, as necessary.
Hold team meetings, encourage open interaction and foster high employee satisfaction. Interview and hire qualified staff.
Assist with client contract management/development, as requested.
Host conference calls with Director/Executive level client contacts as required.
Develop and implement quality monitoring and quality assurance tools for assigned program(s).
|TRAINING, EDUCATION, EXPERIENCE:||Must be 18 years old or older. Bachelor’s degree or relevant experience.
Minimum four years recent healthcare experience (3 years’ direct industry preferred). Expert knowledge of medical insurance (public and commercial), billing and coding and associated terminology.
Exhibit proficiency in Microsoft Office products.
Excellent customer service skills (call center experience required).
Advanced problem solving, research and analytical skills.
Advanced communication skills, both written and verbal.
Advanced client interaction experience required.
SOP development experience required.
Staff training experience required.
Supervisory experience required.
Interview and hiring experience preferred.
|TIME COMMITMENT:||M-F; Minimum 40 hrs full time; may be required to work over 40 hours per week to meet business needs|