The primary purpose of this position is to guide the tracking and projection of payments from Pharmacy Benefit Managers (PBMs) based upon understanding the terms of the PBM contracts with Rite Aid. The manager will track and report revenue received from PBMs with assistance from analysts under their supervision while also working with other Rite Aid departments to ensure full reimbursement based on the contractual terms. The manager must effectively compile and communicate findings to leadership or stakeholders verbally, visually, and in writing (presentation format). Frequent independent judgments are essential. The incumbent is also required to perform all tasks in observance of Rite Aid's brand and strategy and adhere to our core values and service attributes.
Manage pharmacy revenue projections and related reimbursement rate fiscal planning and reporting to ensure that revenue is tracking to fiscal goals based on contract terms with PBMs.
Collaborate with Third Party and A/R accounting teams to ensure optimization of the top-level revenue assurance and reimbursement rate projections.
Lead the creation and execution of complex queries of the pharmacy claims and payment data for revenue assurance projections and contract compliance monitoring. Research escalated issues from revenue assurance analysts, create priorities of work and action plans to resolve issues.
Engage with Managed Care Operations and Strategic Account teams for input regularly and participate in discussions with key customer accounts (PBMs) as necessary.
Develop relationships with any third-party auditors and other Rite Aid departments to ensure positive interactions, resolutions, and outcomes of issues and work with other departments to institute improvements to revenue assurance and contract rate reconciliation processes.
Mentor and manage associates, provide associate feedback, actively participate in weekly staff meetings, provide and/or schedule technology training, and follow-up with associates on assignments.
* Bachelor’s Degree in Arts/Sciences (BA/BS) Business, Finance, or Information Technology required.
*7 years of experience in Financial planning and analysis with at least 2 years of management experience required.
*Advanced Microsoft Excel experience including VBA and Macro code required.
*Experience with a computer programming language such as XML, SQL, HTML or PHP required.
*Tableau experience desirable .
*3 years of experience in PBM, Healthcare or Retail Pharmacy environment and pharmacy claims detail strongly preferred. .
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