Supports the Mgr, Pharmacy OTC by ensuring departmental goals are achieved and all OTC programs meet CMS and State Agency guidelines. Oversees and performs daily OTC requirements by working closely with other departments and external vendors who perform specific duties related to OTC. Responsible for month-end reporting and assists with various analysis and requests from ma
Reports to: Dir, Nat Ancillary Vendor Mgte
Department: CNS-Network Performance
Location: Tampa, Henderson Rdnagement and other departments.
- Serve as "subject matter expert" for assigned areas, including an understanding of the underlying processes. Communicate issues clearly and confidently to Manager and other business owners.
- Monitors and resolves Customer Service inquires according to standards set within OTC programs.
- Coordinates with internal departments to ensure compliance and success of OTC programs by updating impacted departments with any issues or changes to the OTC programs.
- Supports Manager by working with internal departments to ensure the annual OTC changes are completed and all yearly requirements with documentation is in place. Conducts testing when assigned.
- Supports Manager by monitoring and resolving any complaints and grievances to reduce risk of potential CTM.
- Process all OTC vendor invoices and prepare month-end reconciliations and analysis for assigned accounts.
- Ensures all OTC programs meet CMS and State Agency regulations.
- Ensures external vendors have all necessary requirements to perform duties.
- Prepares monthly reporting requirements and creates new reports when necessary to meet business needs. Provides and analyzes monthly metrics for OTC programs. Reports monthly metrics to Finance, Actuary, Product, Markets and OTC Management.
- Performs other duties as assigned.
Education: A High School Diploma. An Associate's Degree preferred.
Experience: 5 years of practical work experience within a healthcare organization preferred.
3-4 years experience in claims processing, appeals, pharmacy call center, billing etc.
Special Skills (e.g. 2nd language): Solid oral and written communication skills.
Solid understanding of MS Office including Outlook, Word and Excel. Ability to learn and utilize internal software application tools.