Blue Cross Blue Shield Association

Director

• leading the end-to-end invoicing and medical rebate operations team
• overseeing client inquiries
• delivering exceptional value to clients
• partnering with Financial Operations and IT leadership on delivery of Synergies’ key initiatives
• driving innovation and translating strategic plans into meaningful implementation strategies

Senior Director – Rebate Invoice and Audit

Consultant

• Conduct global and individual claims and financial audits for BCBSA and affiliated companies
• Manage the audit resolution process to finalize reports
• Verify the accuracy of claims audit documentation and evaluate Plan responses
• Coordinate and track responses to audit findings
• Develop, maintain, and monitor audit resolution tracking reports and spreadsheets
• Analyze and resolve audit issues promptly
• Serve as the primary contact for negotiating audit issue resolutions
• Identify erroneous payments through claims testing and report activities
• Maintain and monitor the Claims Audit Monitoring Tool and audit resolution tracking
• Conduct analysis to enhance controls
• Responsible for auditing, monitoring and reporting the effectiveness of the Program
• Oversee and coordinate BCBSA or Affiliated companies' audits
• Effectively communicate verbally and written to BCBSA or Affiliated companies
• Review BCBSA or Affiliated companies information request, audit inquiries and audit resolution supporting documentation
• Create, review and update departmental policies and procedures
• Advise and ensure the implementation of corrective action plans
• Develop and provide BCBSA or Affiliated companies training

Senior Consultant, Program Assurance Audit

Solutions Engineer

• provide technical leadership, analysis and design facilitation across business, information and technical viewpoints
• establish solution architecture strategy
• lead effective integration of the Enterprise Architecture process
• evaluate existing infrastructure
• lead design, development, and deployment of healthcare business applications
• define technical requirements for strategic projects
• manage priorities and ensure deliverables meet business needs
• guide cross-functional teams and consultants to deliver high-quality solutions
• analyze objectives to identify common patterns and consistent business needs
• develop reference architectures and models for architectural domains
• define architectural evolution and roadmaps for major products
• ensure designs and architecture align to IT security best practices
• provide clear direction and support to business and technical staff

Senior Solutions Architect

Vice President

• Lead and manage high-stakes negotiations with pharmaceutical manufacturers, wholesalers, and other suppliers to secure favorable terms and pricing including VBA’s and cell and gene therapies
• Develop and implement comprehensive negotiation strategies that align with the organization's goals and objectives.
• Build and maintain strong relationships with key stakeholders, including suppliers, manufacturers, and internal teams.
• Analyze market trends, pricing data, and competitive intelligence to inform negotiation strategies and decisions.
• Collaborate with cross-functional teams, including legal, finance, and operations, to ensure successful contract execution and compliance.
• Monitor and evaluate the performance of negotiated agreements, making adjustments as necessary to optimize outcomes.
• Provide leadership and mentorship to the negotiation team, fostering a culture of excellence and continuous improvement.
• Partner with Synergie teams to develop, review, and align strategies and negotiate with pharmaceutical manufacturers; collaborate on rebate bid analysis and rebate agreement process to ensure alignment with corporate goals, performance standards and expected outcomes
• Partner with the Head of Trade Relations and Chief Trade Relations Officer in the development and implementation of strategic initiatives and collaborate with key internal teams to create program/product value to clients, members, providers, and pharmaceutical manufacturers
• Work closely with Synergie teams, related to medical policy and drug list development, pharmaceutical manufacturer programs and contracts, and ongoing evaluation of drug therapy classes for rebate and other financial opportunities; ensure effective communication and strategic collaboration within GPO
• Represent Synergie’s objectives and perspective to external partners (i.e., pharmaceutical manufacturers, clients, others) and communicate to ensure understanding of mutual objectives
• Ensure manufacturers’ products are brought forth internally to evaluate rebate and management opportunities for Synergie’s business
• Serve as a department resource for escalated client issues, contract analysis, and contract language needs in rebate contracting
• Represent Trade Relations on committees to identify net-cost effective policy opportunities; support client alignment and adoption of strategies; assure communication with committee members
• Other duties as assigned

Vice President, Trade Negotiator

• Consult with Client Relations team on Trade related inquiries, initiatives, and opportunity pull through with Participants
• Understands downstream impact of rebate and formulary strategy and can convey appropriate messaging to health plan participants for adoption of said strategies and policies
• Has working knowledge of PBM operations and understanding of drug and UM strategy and policy implementation
• Has experience in reading and interpreting pharmaceutical manufacturer drug contracts and understanding how to align terms and conditions and translate into UM policy and criteria
• Manage medical and pharmacy clinical policies with Participants to ensure manufacturer contract compliance
• Collaborate and support Client Relations team for Trade related inquiries from Participants
• Partner with the following stakeholders: Analytics Team – Collaborate on drug trends and utilization data to inform clinical policy decisions, medical policy and formulary compliance, drug share shift and utilization management strategies
• Client Relations – Serve as Trade’s primary point of contact for all Participant questions on Trade initiatives and manufacturer contracts and escalate issues as needed to Trade’s leadership
• Clinical Team – Liaise with Clinical team to review clinical data and policy requirements as needed
• Invoicing Team – Maintain current library of Participant medical and pharmacy policies and support Invoicing team with manufacturer inquiries regarding clinical policies
• Product Team – Provide medical policy support for manufacturer related contracts including, but not limited to, cell and gene therapies and other outcomes programs

Director, Trade Client Strategy

• Ensure Plans' operations handle customer interactions accurately and promptly, leaving a positive brand impression
• Execute audit programs and validate reported results
• Present updates and recommendations at various events
• Contribute to strategic planning by developing materials, presentations, and documentation
• Create and improve standard operating procedures for departmental functions
• Interact extensively with Plan staff at all levels, requiring diplomacy in difficult conversations
• Influence local and national Plan operations
• Responsible for overall Plan execution of the Operational Audit Programs, including auditing Plans’ local and inter-Plan claim processing, local customer service processing, and enrollment processing in accordance with applicable program
• Analyze performance results and lead cross-functional meetings with Plan stakeholders to facilitate development and completion of action plans for each performance program
• Lead development and administration of various audit initiatives/programs that impact internal and external stakeholders
• Provide Plans education and support via face-to-face training, webinars, Help Desk, one-on-one meetings, and collaborating with other BCBSA staff

Senior Consultant, Performance Audit

Procurement

• Participating and assisting in strategic sourcing projects and activities
• Partnering with internal and external stakeholders to define specifications and requirements
• Conducting market research, data collection and analysis
• Developing/drafting/reviewing contractual documents and supporting contract negotiations
• Managing several sourcing projects and contracts simultaneously with excellent project and time management skills
• Supporting category/contract management efforts and tracking contract progress and utilization
• Preparing reports, written materials, presentations and performing analysis to support assigned categories
• Communicating effectively with stakeholders through meetings, webinars, and presentations
• Reviewing engagement requests, collaborating on requirements and recommending alternate suppliers
• Conducting price analysis, synthesizing data, identifying trends/opportunities and making recommendations
• Supporting bid processes and assessing suppliers' responses to make recommendations