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Supervisor, 3rd Party Operations

Company: Res-Care, Inc.
Location: Taunton
Posted on: June 10, 2021

Job Description:

Our Company


The Supervisor, 3rd Party Analysts is responsible for the direction and coordination of the 3rd Party Analyst team as well as the coordination of transactions between PharMerica and 3rd party payers. The supervisor will interact with appropriate departments to provide operational support and ensure integrity of third party plan and claim information.


  • Works in conjunction with the 3rd Party Operations Manager to establish analyst level goals, department wide goals, performance tracking and quality assurance metrics Clearly communicates roles and responsibilities of analysts and provides guidance and leadership to staff Establishes and maintains professional and effective relationships with staff, peers, payers, and other stakeholders Serves as a liaison with staff and payers or internal departments to coordinate and troubleshoot various claim, payer, or other industry related issues Works to update, or create and maintain Standard Operations Procedures for the department, including clearly outlining training plans for new or underperforming analysts Ensures team assignments are fair and balanced based on analyst's skills sets Manages staff attendance and time sheets for payroll (Day Force) system. Assures staff is meeting attendance policies and reports any variations to Manager. Holds regularly scheduled meetings with staff to discuss performance metrics and ensure employees are on track to meet their goals Enforces disciplinary action and creates performance improvement plans as needed for underperforming staff Create and manage reporting opportunities to mitigate third party rejections, reduce revenue loss, and implement process improvements. Stays up to date on third-party billing requirements and reimbursement guidelines Serves as a Subject Matter Expert (SME) for the organization on internal claims billing system and industry relations Participates in meetings of the National Council for Prescription Drug Programs (NCPDP), representing the interests of PharMerica and the long term care pharmacy perspective Collaborates regularly with Contracting, Purchasing, Claims Processing, Accounts Receivable, Cash Processing, Facility Billing, Admissions, Census, Plan Administration, IT, and other areas of the company Ensures communications impacting other areas of the company are distributed properly and timely Performs other tasks as assigned Conducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Each essential function is required, although reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions


Education/Learning Experience Required: Associate's degree, relevant technical certification, or equivalent work experience Desired: Bachelor's degree Work Experience Required: 2+ years experience in a supervisory, managerial, or leadership role Required: 5+ yrs experience working as a Pharmacy Technician, or in a billing potion within a healthcare setting Required: 3+ yrs experience with pharmacy or health data analysis Required: 2+ yrs experience working in a Pharmacy, Long Term Care, or Managed Care setting Desired: Specialized understanding of billing requirements for Medicare Part D or Medicaid

Skills/Knowledge Required: Must be a good leader Required: Ability to maintain confidentiality Required: Proficiency in MS Office Products (Excel, Word) and basic computer knowledge Required: Excellent verbal and written communication skills, and C-level presentation skills Required: Ability to effectively navigate ambiguous situations with limited direction Required: Able to handle high volume and significant workload Required: Familiarity with long term care pharmacy or facility billing practices Desired: AS400 computer system experienceLicenses/Certifications Required: None

About our Line of Business

PharMerica is a full-service pharmacy solution providing value beyond medication. PharMerica is the long-term care pharmacy services provider of choice for senior living communities, skilled nursing facilities, public health organizations and post-acute care organizations. PharMerica is one of the nation's largest pharmacy companies. PharMerica offers unmatched employee development, exceptional company culture, seemingly endless opportunities for advancement and the highest hiring goals in decades. For more information about PharMerica, please visit www.pharmerica.com. Follow us on Facebook, Twitter, and LinkedIn.

Additional Job Information

Must be available to work 8:30 - 5 pm.

Colorado Pay Min

Colorado Pay Max

Keywords: Res-Care, Inc., Taunton , Supervisor, 3rd Party Operations, Other , Taunton, Massachusetts

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