Reimbursement Supervisor

Job Summary:

The Reimbursement Supervisor will supervise specialty pharmacy reimbursement/revenue cycle management operations (billing/collections/clearance), manufacturer services (“HUB”) operations, and wholesale reimbursement operations to ensure proper contractual reimbursement from insurance companies, third party payors, patients and other customers for services provided. The Reimbursement Supervisor will provide guidance and direction to staff covering all aspects of billing and collection standards/procedures, ensures adherence to policies and procedures and initiates correspondence to insurance companies for reconsideration of claims.

The below is intended to describe the general content of and requirements for the performance of this job and is not to be construed as an exhaustive statement of essential functions, responsibilities, or requirements.

Primary Duties and Responsibilities

1.Supervise daily (1) specialty pharmacy intake/clearance, billing, collections, cash posting and call center activities, (2) HUB intake, clearance, and prescription triage activities, and (3) wholesale credentialing, order processing, invoicing, collections, and cash posting to ensure maximum efficiency.

2.Monitor processing of denials and secondary billing requirements to ensure prompt follow-up.

3.Ensure the timely and accurate submission of invoices to the responsible payer for services and products provided.

4.Supervise, mentor, develop, and train staff as needed for continual improvement.

5.Create training documents for new drug launches and use those documents to train dedicated teams on business rules, process flows, and SOPs as needed for the new drug launch.

6.Know acceptable reimbursement ranges for each AnovoRx drug and be able to convert reimbursement rates expressed in WAC and pre-settlement AWP to post-settlement AWP equivalency.

7.Must know and be able to apply the Company’s policy of restrictions on and acceptable waiver of co-payments and provision of reduced price or free goods.

8.Ensure adequate phone coverage during published business hours for reimbursement, HUB and wholesale phone lines.

9.Ensure staff are meeting or exceeding call quality policies and standards on all inbound and outbound calls.

10.Responsible for conducting regular call quality auditing and reporting on staff as needed.

11.Adhere to all drug manufacturers business rules during the daily patient clearance process.

12.Understand and maintain the ability to train staff on manufacturer-specific SOP’s and expectations.

13.Ensure staff are appropriately trained on AnovoRx, VAWD and other relevant policies and procedures as determined from time to time by the Company.

14.Works collaboratively with other departments, including operations and managed care, to improve reimbursement process and results.

15.Compile and prepare data for the Daily Dedicated Dashboard reporting.

16.Report on the current patient statuses in the Dedicated Pharmacy Dashboard meetings.

17.Continuously assesses processes for areas of improvement for efficiency and accuracy.

18.Participate in interviewing prospective employees and conduct regular performance discussions with current employees.

19.Work independently on projects as assigned by the manager.

20.Regular and reliable attendance expected.

21.Other work-related duties as assigned by supervisor/manager.

Minimum Knowledge, Abilities, and Skills Required

1.A minimum of a high school diploma or equivalent required.

2.1-2 years of prior supervisory experience preferred.

3.Must have a minimum of 3 years’ experience in a health care billing or reimbursement related function and/or organization.

4.Must be highly motivated, people friendly, organized and detail oriented.

5.Must not have history evidencing any dishonesty, lack of trustworthiness, or workplace violence.

6.Must have excellent computer skills; proficient with Microsoft Office Suite (primarily Word, PowerPoint, and Excel.)

7.Able and willing to work any required Anovo operating shift within the hours of 7am-7pm Monday-Friday.

8.Must have history evidencing reliability and consistency in timeliness, attendance, and quality of work.

9.Must present yourself professionally on the phone and in person.

10.Must articulate thoughts well and communicate them clearly, both verbally and in writing.

11.Must pass Company’s drug test and background screening prior to start of employment.

This description is intended to be only a general outline of major activities. It is expected that the employee performs these and any other activities which may be assigned, or which may occur in the normal course of work. This description is not a contract or guarantee of employment. AnovoRx is an Equal Opportunity Employer.