Coverage Determination Manager Part B
Under the leadership of the Operations Director the main objective of this role is to provide ongoing oversight of the Coverage Determination Team managing Part B claims. This team is accountable for managing major medical insurance claims. The team will work with coverage eligibility, submit claims, follow up with plan to obtain pre authorization, obtain information and documents required for evaluation and transfer the case if financial assistance is needed. The Manager will manage all aspects of the department functions, including personnel, systems, initial and on going training and employee development, The Coverage Determination Manager Part B will also serve as the Training subject matter expert (SME) for the Operations team working in partnership with the Training & Development Manager.
Responsibilities include but are not limited to:
- 2 years of leadership/people management experience is required
- Prior experience working in health plan
- Demonstrated track record of meeting/exceeding goals
- Skilled at building relationships (e.g. Payers)
- Prior experience working in Specialty Pharmacy preferred
- Knowledge of Access and Reimbursement matters is preferred.
- Knowledge of Microsoft Office programs (Word, Excel, Outlook) is required;
- Knowledge of CPR+ (preferred)
- Ability to communicate effectively in English and Spanish (preferred) .
- Pharmacy Technician Associate Degree -Pharmacy license and registration
- Bachelor’s degree in healthcare or business-related field (preferred)