FIU Manager – Model & Analytics
SouthState Bank
Manager, Mac and Process Development
Maxor National Pharmacy Services, LLC
full-time
Posted on:
Location Type: Remote
Location: Remote • Texas • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
Tech Stack
PythonSQLTableau
About the role
- Develop business, industry, competitive, client, and technical knowledge to formulate pricing strategy, and to execute financial modeling of comprehensive pricing strategies
- Consult with internal leaders and departments to coordinate relevant cross functional activities in support of network performance management efforts to maximize the organization’s competitive position
- Execute and implement dynamic pricing strategies in response to market fluctuations to provide competitive, profitable, and best of class pricing offers
- Collaborate with the Underwriting team to provide recommendations on pricing and negotiation strategy to achieve revenue, support re-pricing process, profitability targets, and margin retention, for new and existing customers
- Support VytlOne consulting opportunities related to MAC / Network pricing including, but not limited to: generating financial models to reprice claims and calculate MAC pricing provide insights on proposals assist in implementation strategies
- Build process to validate data transmissions for accurate adherence to our rate guidelines and MAC prices
- Establish, maintain, and adjust as necessary a MAC pricing algorithm in coordination with company strategy, contractual financial obligations, market conditions, and adherence to state MAC laws
- Develop understanding of claim adjudication pricing parameters and lead process development to automate network / MAC builds and pricing adjustments while incorporating QA validation
- Oversee the MAC Appeals process ensuring proper intake and response to all appeals in accordance with applicable MAC Appeal laws
- Develop and maintain MAC reference file to track and support MAC setups inquires
- Provide Pharmacy Audit support and develop a process to track Audit findings and coordinate those findings with Finance
- Build and maintain claim re-pricing process that forecasts Pharmacy, Client, and Member pricing impact
- Coordinate with VytlOne Rebate team in process review / development in effort to optimize rebate pricing strategies
- Identify gaps in current processes and provide / implement recommendation to streamline efficiencies and quality
- Assist in the creation and support of a process to intake, catalog, and respond to Network Disruption and Access requests
- Provide as needed support and training for process development tools (such as Alteryx) – as well as support of automation implementation strategies - to bolster VytlOne's automation efforts
- Promptly report any allegations of impropriety to the Compliance Department. Comply with Maxor’s Ethical Business Conduct policy and Maxor’s Compliance Program. Remain free from exclusion under the OIG and SAMS Medicare/Medicaid lists.
- Complete required training, as assigned, within the established timeframes.
- Must be able to cope with the mental and emotional stress of the position.
- Ensure staff is informed of product upgrades or enhancements in a timely manner.
- Hire and train competent staff.
- On a biweekly basis, verify departmental timesheets for departmental employees ensuring the timesheets are accurate based on the work-schedule and necessary corrections are done prior to timely Payroll submission.
- Develop and mentor departmental staff by providing career coaching; motivate departmental staff, individually and as a group; understand and support diversity; and establish an effective team.
- Conduct initial and annual performance evaluations.
- Promote teamwork; discipline staff when warranted.
Requirements
- Bachelor’s Degree in Finance, Accounting, Math, Business, Computer Science, or related area of study
- Experience in Analytics including large data sets, MAC modeling, and process automation.
- Preferred experience in a PBM setting.
- Excellent management and planning skills, detail oriented.
- Strong analytical and problem solving skills.
- Ability to organize and manage multiple priority tasks simultaneously.
- Proven and demonstrated project management skills, directing project activities to a cross-functional team.
- Problem solving ability in unstructured situations.
- Ability to lead effective meetings, accomplish goals and meet timelines.
- Ability to work well in cross-functional situations, giving clear direction and partnering with other internal departments to reach common goals.
- Ability to manage, mentor, and develop team members with expertise on MAC pricing and the adjudication systems with particular emphasis on developing processes that are both accurate and efficient.
- Experience influencing change and adoption of new analytic capabilities to support pricing financial analytics.
- Experienced user of two or more of the following: SQL, SAS, Alteryx, Tableau, Power BI, R, or Python technologies.
Benefits
- Comprehensive mental health and wellbeing resources
- Nationwide Blue Cross Blue Shield PPO with employee-friendly plan design, including a $850 individual annual medical deductible and $25 office visit copays, with low biweekly premiums
- Company-paid basic life/AD&D, short-term and long-term disability insurance
- Rx, dental, vision, other voluntary benefits, and FSA
- Employer-matched 401k Plan
- Industry-leading PTO plan
- And more!
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
financial modelingdynamic pricing strategiesMAC pricing algorithmclaim adjudication pricingprocess automationdata validationproject managementanalyticspricing strategyre-pricing process
Soft skills
management skillsplanning skillsanalytical skillsproblem solvingorganizational skillsteam leadershipmentoringcommunicationcross-functional collaborationstress management
