Copay Manager - Support Program/Claims Processing

The Copay Support Program Manager is a critical role within the organization and is primarily responsible for the creation, design, set-up and administration of Pharmacy and Medical Copay programs for AssistRx manufacturer clients. Required engagement with client, account managers, program managers, finance team members and other departments within the organization to implement and support all operational and financial processes related to claim processing activities. In addition, manager will ensure effective day-to-day operations and provide ongoing Copay program metrics for internal and external business review meetings. Responsible for forecasts and analyzing claims data to determine Copay utilization, establish escrow account minimum balances as well as replenishment needs. This position will identify and report Copay trends, patterns and behaviors as well as make recommendations to increase utilization based on Copay claims and patient compliance/adherence activities. Also, this position will implement data-driven initiatives to achieve operational and process excellence that will optimize and increase the number of Copay Programs supported and managed by AssistRx.

• The Global Copay Program Manager will serve as the primary client contact for developing, implementing, enhancing, and managing pharmaceutical Copay programs
• Primary Patient Solutions contact assisting in affordability program design, affordability program business rules determination, set-up and maintenance of Copay programs and other AssistRx adjudicated program offerings
• Support the development and implementation of existing and new Copay programs including troubleshooting, communicating with internal program leaders, program vendor(s), administrator(s), pharmacies, sites of care as well as patients
• Partner with internal and external stakeholders with respect to program design, program improvements and/or changes
• Define and execute the work plan for program staff.
• Manage the day-to-day activity of the program(s) and supervising the Copay team
• Maintains a great work environment by teaching, training, developing and coaching HUB personnel on Copay programs and claim adjudication troubleshooting
• Have significant participation in programs' strategic planning and be accountable for proper execution of contract terms for assigned program(s)
• Manage the client relationship, gaining trust and building rapport
• Work cross-functionally with internal stakeholders for successful program operations
• Participate with Hub Services leadership and client team on initiatives to improve process and performance
• Gains a thorough understanding of the adjudication claims engines and networks, including the variation of system logics across multiple adjudicators
• Must be proficient in accessing data from affordability program platforms and being able to analyze its significance regarding the functioning of a program's business rules
• Responds to and resolves business rule questions or concerns escalated from internal teams or adjudicators
• Responsible for performing quality control on new Copay program set-ups and any requested updates
• Develops reports reflecting Copay claim activities and provides to the business leaders for presentation to the clients
• Participates in client facing calls and internal training presentations as the need arises
• Uses appropriate measurement, analysis and evaluation methods to accurately identify and document improvements
• Partners with finance team on Copay claim billing and escrow balances
• Responsible for data integrity
• Acts as a Subject Matter Expert and key contributor on complex or critical assignments, related to Copay and/or other affordability programs
• Performs other related duties as assigned by management
  
  

Requirements

• Bachelor's Degree (BA) from four-year college or university, or one to two years of related experience and/or training, or equivalent combination of education and experience
• Certificates, licenses and registrations required: Pharmacy and Medical Claim Processing
• Computer skills required: Contract Management Systems; Microsoft Office;
• Other skills required: Pharmacy Data Management (PDMI), eCard Platform, Medical Claims
  
  

COMPETENCIES:

• Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce
• Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values
• Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures
• Business Acumen - Understands business implications of decisions; Displays orientation to profitability; Demonstrates knowledge of market and competition; Aligns work with strategic goals
• Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings
• Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks; Develops realistic action plans
• Strategic Thinking - Develops strategies to achieve organizational goals; Understands organization's strengths & weaknesses; Analyzes market and competition; Identifies external threats and opportunities; Adapts strategy to changing conditions
• Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information
  
  

Benefits

• Supportive, progressive, fast-paced environment
• Competitive pay structure
• Matching 401(k) with immediate vesting
• Medical, dental, vision, life, & short-term disability insurance
  
  

AssistRx, Inc. is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors, or any other protected categories protected by federal, state, or local laws.

All offers of employment with AssistRx are conditional based on the successful completion of a pre-employment background check.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. Sponsorship and/or work authorization is not available for this position.

AssistRx does not accept unsolicited resumes from search firms or any other vendor services. Any unsolicited resumes will be considered property of AssistRx and no fee will be paid in the event of a hire.