Network Contracting Manager at SS&C Technologies in Kansas City, MO
Job Description:
Organizational Overview As an Associate with SS&C Health, you will be part of an organization that promotes better health outcomes for consumers through clinical and technological innovations. We accomplish this by leveraging the robust technology foundation and powerful analytic resources that are the core of SS&C, with industry leading clinical expertise and strategic pharmacy and healthcare solutions. You will join a team that is redefining the value of pharmacy in healthcare through the integration of advanced analytics, clinical insights and transformative digital capabilities. Role Overview Manages the networks for SS&C network pharmacy customers. Manages the development, implementation, and operations of credentialing of participating pharmacy providers. Maintains relationships with pharmacy chains and PSAOs, as well as national pharmacy organizations, i.e. NCPDP . Manages contract negotiation status with current and potential participating pharmacies. Monitors and maintains the pharmacy networks to ensure networks are processing appropriately or make updates as needed to correct errors or resolve issues within the pharmacy network claims adjudication system. Manage pharmacy network team members. Responsibilities Maintains relationships with pharmacy chains and PSAOs, as well as national pharmacy organizations, i.e. NCPDP Cultivates effective relationships with pharmacy provider representatives, client representatives and internal stakeholders, including adherence to agreed-upon rules of engagement and roles & responsibilities. Manages contract negotiation status with current and potential participating pharmacies Monitors and maintains the pharmacy networks to ensure networks are processing appropriately or make updates as needed to correct errors or resolve issues within the pharmacy network claims adjudication system. Manage one or more pharmacy network team members. Provide other assistance as needed to the pharmacy networks team and other departments including the Implementation team. Act as the pharmacy network claims adjudication system subject matter expert including being the main contact for questions or issues related to the pharmacy network claims adjudication system (escalating issues as needed). Responsible for researching and resolving complex network issues, including rate discrepancies and conflicts between pharmacy relationships and client business needs. Adheres to strict procedural and regulatory compliance quality standards, including thorough and accurate documentation, testing protocols, and claims analysis. Responsible for monitoring the pharmacy rates on an ongoing basis Sets high standard and encourages new ideas for improving organizational performance Utilizes planning, prioritizing, and organizational skills to ensure timely deliverables, high levels of quality, and efficient use of resources Maintains commitment to operational goals in the face of obstacles Provides day-to-day business processes and quality standards and measurement criteria Manages processes to achieve service commitments, including sustainable, measurable, accurate and timely execution of project deliverables Promptly responds to service failures, resolves issues, and escalates concerns as appropriate Promotes continuous improvement by ensuring adherence to quality principles Seeks out and actively participates in business initiatives that contribute to service excellence Based upon career path level, completes special projects and assignments (such as such as leading workgroups, overseeing projects, mentoring team members, etc.) Manage the daily activities of the Network Operations team including staffing models, workflow management and credentialing support duties Provides escalation and resolution of any and all Network related issues Support the Director of Network Contracting in all network related deliverables Holds direct reports accountable for meeting performance standards and departmental performance goals; mentors' staff; measures staff performance and completes regular performance reviews and rankings. Create and maintain a quality assurance culture within the department in all work processes and outcomes Works across the organization, with clinical and administrative areas, to develop and deploy provider systems, standards, policies and procedures to improve network performance. Qualifications Bachelor's degree and 6 years of work-related experience, or Master's degree and 4 years of work-related experience, or 8 years equivalent work-related experience Experience in managing direct reports Ability to understand and/or have experience with NCPDP standards and requirements. Proven track record of developing, maintaining and testing claims adjudication systems or pharmacy networks. Strong communication skills with the ability to develop effective working relationships with internal and external stakeholders
Salary Range:
$200K -- $250K
Minimum Qualification
System & Network Administration, Technology ManagementEstimated Salary: $20 to $28 per hour based on qualifications.
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