Supervisor Pharmacy Helpdesk

SUMMARY:   

The Part B Supervisor is responsible for the management of staff responsible for answering provider and member calls.  This position is responsible for ensuring BCBSM Medicare Advantage plans meet CMS compliance requirements the pharmacy contact center, coverage decisions, appeals, and grievance process. 

RESPONSIBILITIES/TASKS: 

• Identifies, resolves, and reports on all compliance issues.
• Develops and maintains a clear and comprehensive reporting package of compliance activities.
• Delivers required documentation for CMS and internal audits.
• Actively participates in departmental initiatives for continuous improvement.
• Balances workload to optimize the effectiveness of the department.
• Leads and participates in workgroups to implement new requirements and resolve issues.
• Oversees communication pieces related to Medical Drug Benefit programs.
• Maintains an excellent relationship with servicing areas to ensure best in class outcomes for our members and providers.
• Supervises an administrative staff responsible for pharmacy help desk calls.
• Maintains and promotes quality relationships with internal team and external vendors and stakeholders.
• Participates in development of annual departmental budget, monitors budget, and identifies budget discrepancies.  Research cause and make recommendations, as needed.
• Responsible for balancing workload to optimize the effectiveness of the department.

DIRECTION EXERCISED:

Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws.  Responsibilities include, but are not limited to, effectively interviewing, hiring, terminating, and training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.

This position description identifies the responsibilities and tasks typically associated with the performance of the position.  Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION:

Bachelor’s degree in business administration, Health Care Administration, Marketing, or a related field.    Valid and unrestricted driver’s license is required.   Relevant combination of education and experience may be considered in lieu of degree.  Continuous learning, as defined by the Company’s learning philosophy, is required.  Certification or progress toward certification is highly preferred and encouraged.

EXPERIENCE: 

Five years experience of progressive responsibility in a business environment with demonstrated technical knowledge that provides the necessary knowledge, skills and abilities required.  One year supervisory or leadership experience in business is required. 

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: 

• Knowledge of pharmacy claims processing
• Knowledge of medical claims processing, specific to Part B drug
• Understanding of utilization management programs
• Familiarity with Medicare Guidelines and Timeframes
• Knowledge of health insurance compliance.
• Excellent analytical, organizational, planning, verbal, and written communication skills.
• Self-motivated with the ability to work well under pressure.
• Proficient in current industry standard PC applications and systems.
• Must demonstrate leadership ability and team building skills to effectively supervise professional and non-professional staff and interact with all levels of management.
• Ability to work with and empower others on a collaborative basis to ensure success of unit team.
• Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions, and employing active listening techniques.
• Ability to effectively present budgetary and/or cost information and respond to questions as appropriate.
• Ability to establish workflows, manage multiple projects, and meet necessary deadlines.

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. 

PAY RANGE:
Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $70,100 and $117,400.

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The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description. 

We are an Equal Opportunity Employer.  Diversity is valued, and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis.  Nothing herein is intended to create a contract.

Salary : $70,100 - $117,400