Supervisor, Provider Relations

Job Title: Supervisor, Provider Relations

Reports to: Senior Manager, Pharmacy Services

Location: Remote

FLSA Status: Exempt

Job Summary

Within the Pharmacy Services Department, the Supervisor, Provider Relations is responsible for managing and prioritizing work of the Senior Provider Relations Representatives and Provider Relations Representatives within the Pharmacy Services department. The position oversees the frontline team that is point on fielding AlignRx community pharmacy member inquiries via phone and email. This requires deep knowledge of all AlignRx programs and services and an overall understanding of the pharmacy industry, including community pharmacy, health plans, pharmacy benefit managers, Medicare, and Medicaid.

Essential Job Functions

  • Serve in leadership role to Senior Provider Relations Representatives and Provider Relations Representatives, ensuring defined goals and objectives are met.
  • Maintain knowledge of existing and newly launched AlignRx programs and services.
  • Remain current on pharmacy industry trends and aware of AlignRx pharmacy member business needs and concerns.
  • Implement training programs and provide tools/resources for team member use and education.
  • Serve as an escalation point for the purpose of pharmacy member issue resolution.
  • Define and implement efficient department workflow, policies, and procedures.
  • Oversee the onboarding and ongoing training process for Senior Provider Relations Representatives and Provider Relations Representatives.
  • Monitor phone queue performance daily to ensure improved performance and goals met.
  • Report phone queue issues to Operations for resolution.
  • Prepare monthly management reports, including preparing the Provider Relations phone queue report.
  • Review and approve pharmacy network communications, as needed.
  • Review daily Pharmacy Data Management System (PDMS) Notes report for determining appropriate follow-up and timely issue resolution.
  • Interface and collaborate with Payor Contracting, Audit Assistance, Credentialing, Reconciliation Services, IT, Clinical Services, and Finance for the purpose of issue resolution and defining efficient processes.
  • Validate bi-monthly payroll for Provider Relations department.
  • Review and approve PTO for team members in accordance with company policy.
  • Maintain monthly calendars for scheduling Senior Provider Relations Representatives and Provider Relations Representatives rotating late day.
  • Lead the interview process for the hiring of Senior Provider Relations Representatives and Provider Relations Representatives.
  • Conduct performance evaluations in accordance with company policy.
  • Serve on the FWA committee to conduct research and feedback on the Provider Relations review portion.

Minimum Qualifications

Education

  • Bachelor’s degree in a business-related field preferred.
  • Two to three years as a pharmacy technician in a retail pharmacy environment.

Experience

  • Five or more years as a pharmacy technician in a retail pharmacy environment.
  • Healthcare-related experience.
  • Two years PSAO experience (preferred).

Additional Responsibilities

  • Perform other duties or projects as assigned by senior management.

Knowledge, Skills & Abilities

  • Strong sense of customer service.
  • Excellent verbal and written communication skills.
  • Good interpersonal skills with the ability to work and communicate effectively with all levels of co-workers, clients, and other external contacts.
  • Strong organizational and time management skills.
  • Dependable with good attendance and adherence to timelines and schedules.
  • Good problem-solving and analytical skills.
  • Consistent follow-through on issue resolution.
  • Resourceful, with the ability to take initiative in development and completion of projects.
  • Basic computer knowledge through effective use of a personal computer including Microsoft Office applications, specifically: file management skills, Internet, Microsoft Windows, database, word processing (Word), spreadsheets (Excel), presentation software (PowerPoint), graphics.
  • Knowledge of and experience in the pharmacy and healthcare industry regarding terminology and retail pharmacy operations, including understanding of how and why pharmacy claims process (e.g., calculation of copayments, pricing hierarchies).
  • Basic drug knowledge and understanding of Therapeutic Categories (TC), Multi-Source Indicators (MSI), Generic Product Identifier (GPI), Generic Code Number (GCN), Drug/claim statuses: Paid vs. Captured; PDL/NPDL; “F” – Formulary (paid) vs. “G” – Non-formulary paid.

Physical Requirements/Working Conditions

  • Sedentary work, requiring the following physical activities: sitting for long periods of time; occasional bending, squatting, kneeling, stooping; good finger dexterity and feeling; frequent repetitive motions; talking, hearing, and visual acuity.
  • Lifting of up to 20 pounds of paper supplies or minor office equipment.
  • Conducting work in a business-type environment (e.g., desk, table) that can facilitate the use of two computer monitors.
  • Driving to client locations and other sites, as needed.

Direct Reports

  • Senior Provider Relations Representative and Provider Relations Representatives.

NOTE: The above statements are intended to describe the general nature and level of work performed by an employee in this position. These statements are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of employees in this position.

AlignRx is an equal opportunity employer and is committed to providing a workplace free from harassment and discrimination. We celebrate unique differences of our employees, knowing diversity drives innovation and the success of our business. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, gender identity or expression, age, marital status, veteran status, disability status, pregnancy, parental status, genetic information, political affiliation, or any other status protected by applicable laws or regulations.

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Supervisor, Provider Relations