IMM Program Supervisor

Overview

Responsible for reimbursement and administrative supervisory work in the coordination of program services, quality assurance and personnel services within the program. Work involves the identification and implementation of program policies and procedures as directed by standard operating and program specific procedures. Work is performed with latitude for independent judgment, and action is reviewed by the Program Manager through conferences, reports and observation of results obtained.

Responsibilities

• Liaison between Program Manager and Team
• Keeps the Program Manager abreast on all aspects concerning the Program
• Plans daily schedule, assigns tasks and ensures daily goals are met
• Submits daily and weekly reports to the Program Manager regarding productivity statistics at both the team and employee level
• Provides organization and direction for daily reimbursement support according to the scope of services provided in the statement of work
• Evaluate and monitor Program needs, identifies unmet needs and provides recommendations for internal process improvement and workflow efficiency

• Follows program guidelines and assists with the implementation of process improvements
• Serves as an advocate to patients and healthcare professionals regarding insurance coverage, medical billing, reimbursement process, and general access for complex pharmaceuticals
• Ability to perform thorough insurance benefit investigations, communicate insurance coverage to patients and providers, guide and follow up on prior authorizations, and assist with appeal processes
• Provides counsel and strategies on complex coverage and reimbursement issues to patients and healthcare providers, and works on patients’ behalf to identify and assess reimbursement coverage options
• Establishes relationships, develops trust, and maintains rapport with patients and healthcare providers; Acts as an assigned liaison to client contacts (e.g., regional contact for sales representatives)

• Preparation of and participation in client audits
• Communicates and coordinates with inter-departmental stakeholders to resolve program specific escalations, conflicts and/or questions
• Problem solves issues with autonomy and serves as first line of escalation for complex reimbursement issues

• Routinely conducts quality assurance activities through reviews, meetings, reports, observation of results, according to standard operating procedures, program specific procedures and regulatory compliance

• Participates in and conducts meetings, as necessary
• Responsible for performance management including but not limited to, coaching and mentoring subordinates, employee counseling, employee performance appraisals, conflict resolution and schedule adherence

Other responsibilities, as assigned

Qualifications

• Bachelor’s degree and 4 years of reimbursement/insurance, healthcare billing, physician office, health insurance processing preferred or in lieu of a degree, a High School diploma or equivalent with 5 years of reimbursement/insurance, healthcare billing, physician office, health insurance processing 
• 3-5 years supervisory experience with progressive levels of responsibility within a service driven environment
• Extensive knowledge of pharmacy benefit methodologies for pharmaceuticals
• Extensive knowledge of Medicare, Medicaid, and private payer payment methodologies
• Impeccable communication skills
• Initiative and strong work ethic critical
• Confident in supervising a team professionally, consistently and fairly
• Ability to lead within a fluid and dynamic environment
• Ability to multitask and prioritize in a fast-paced environment

• Excellent problem-solving and decision-making skills required
• Attention to details
• Strong organizational skills