Program Supervisor

Key Responsibilities

• Responsible for performance management including but not limited to, coaching and mentoring subordinates, employee counseling, employee performance appraisals, conflict resolution and schedule adherence
• Liaison between Program Manager and Team
• Keeps the Program Manager abreast on all aspects concerning the Program
• Plans daily schedule, assigns tasks and ensures daily goals are met
• Submits daily and weekly reports to the Program Manager regarding productivity statistics at both the team and employee level
• Provides organization and direction for daily reimbursement support according to the scope of services provided in the statement of work
• Evaluate and monitor Program needs, identifies unmet needs and provides recommendations for internal process improvement and workflow efficiency
• Follows program guidelines and assists with the implementation of process improvements
• Serves as an advocate to patients and healthcare professionals regarding insurance coverage, medical billing, reimbursement process, and general access for complex pharmaceuticals
• Ability to perform thorough insurance benefit investigations, communicate insurance coverage to patients and providers, guide and follow up on prior authorizations, and assist with appeal processes
• Provides counsel and strategies on coverage and reimbursement issues to patients and healthcare providers, and works on patients’ behalf to identify and assess reimbursement coverage options
• Establishes relationships, develops trust, and maintains rapport with patients and healthcare providers; Acts as an assigned liaison to client contacts (e.g., regional contact for sales representatives)
• Preparation of and participation in client audits
• Communicates and coordinates with inter-departmental stakeholders to resolve program specific escalations, conflicts and/or questions
• Problem solves issues with autonomy and serves as first line of escalation for complex reimbursement issues
• Routinely conducts quality assurance activities through reviews, meetings, reports, observation of results, according to standard operating procedures, program specific procedures and regulatory compliance
• Identify and report pharmacovigilance information as required by client(s) (i.e., Adverse Events)
• Participates in and conducts meetings, as necessary
• Responsible for performance management including but not limited to, coaching and mentoring subordinates, employee counseling, employee performance appraisals, conflict resolution and schedule adherence.
• Utilize Valeris’ values as the driving force behind the team’s success
• On time adherence to training deadlines for all corporate policies and procedures
• Ensure all SOPs are followed with consistency
• Perform additional tasks or projects as assigned

Qualifications

• Bachelor’s degree and 2 years of reimbursement/insurance, healthcare billing, physician office, health insurance processing preferred or in lieu of a degree, a High School diploma or equivalent with 4 years of reimbursement/insurance, healthcare billing, physician office, health insurance processing
• 3-5 years supervisory experience preferred with progressive levels of responsibility within a service driven environment
• Extensive knowledge of pharmacy benefit methodologies
• Extensive knowledge of Medicare, Medicaid, and private payer payment methodologies
• Initiative and strong work ethic critical
• Ability to lead within a fluid and dynamic environment
• Excellent problem-solving and decision-making skills required
• Attention to details
• Strong organizational and communication skills

Physical Demands & Work Environment

Why Work for Valeris?

Our Commitment to Equal Opportunity