Manager, Pharmacy Financial Operations

Location: Remote (For Non-Local) or Hybrid (Local to NYC area)

About this Role

The Manager, Pharmacy Financial Operations is a highly visible and critical position being added to the Finance team at Capital Rx, who will manage the Pharmacy Financial Operations. This role supports a team of analyst who primarily support pharmacy reimbursement functions. This consist of managing and overseeing the vendor setup of providers, delivery of remittances via 835 and overall pharmacy related payment inquires. The manager will partner with all departments across the organization.

Position Responsibilities:

• Lead a team of analysts to ensure compliance of payment and inquiry turnaround times
• Establish a process to enhance communication between provider contracting team
• Support reimbursement implementations to ensure accurate setup
• Interpret and recommend updates required to ensure pharmacy reimbursement are paid accurately and timely.
• Manage and oversee any state prompt pay reporting required
• Lead development and implementation of technology solutions to improve reimbursement(s)
• Drive and execute process improvement to scale the pharmacy financial operations workflow.
• Effectively communicate with legal, finance and other key pharmacy related teams
• Responsible for managing and accrual process of pharmacy receivables
• Drive continuous improvement within the finance organization to streamline processes and improve communication and flow of information to the business (KPIs and monthly reporting)
• Support all accounting and month end requirements
• Adhere to all state and regulatory reimbursement compliance.
• Ad hoc projects as needed.
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

Required Qualifications:

• 4+ years of PBM experience, Managed Care, Medicare, Medicaid contracts preferred
• Understanding of retail pharmacy reimbursement methodologies and terminology
• Knowledge of NCPDP (National Council for Prescription Drug Programs) D.O. standards
• Experience with Powerbi/Tableau/Looker or other data visualization tools helpful
• Bachelor’s degree or a closely related field (In lieu of a degree, equivalent relevant work experience may be considered.)
• Proficiency in Excel, (SQL, Python helpful)
• Ability to challenge and improve existing processes through automation and redesign
• Motivated team player with the ability to work in a fast-paced, forward-moving environment
• Experience performing complex analyses on large sets of data
• Knowledge of data management, statistics, modeling
• Experience working with structured and unstructured data
• Track record of leading cross-functional initiatives, driving high performance, meeting deadlines, and executing on deliverables
• Ability to balance multiple complex projects simultaneously
• Exceptional written and verbal communication skills
• Extremely flexible, highly organized, detail oriented, and able to shift priorities easily
• Attention to detail & commitment to delivering high quality work product

Base Salary: $90,000 - $115,000

Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

About Capital Rx

Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nation’s electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B Corp™, Capital Rx is executing its mission through the deployment of JUDI®, the company’s cloud-native enterprise health platform, and a Single-Ledger Model™, which increases visibility and reduces variability in drug prices. JUDI connects every aspect of the pharmacy ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of pharmacy benefits and rebuilding trust in healthcare.

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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