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VytlOne · 2 months ago

Manager of Mac and Process Development

United States

Full-time

Remote

Mid, Senior Level

VytlOne is the nation’s only independent, fully integrated total pharmacy solutions partner. The Manager of MAC and Process Development is responsible for the execution and optimization of MAC/pricing strategies, leading financial modeling, and developing reimbursement strategies in collaboration with other team leaders.

Health CarePharmaceutical

Growth Opportunities

Responsibilities

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

Qualification

Financial modelingMAC pricing strategyProcess automationSQLSASAlteryxTableauPower BIRPythonAnalytical skillsProject managementTeam managementProblem solvingCommunication skills

Required

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

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

Preferred

Preferred experience in a PBM setting

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!

Company

VytlOne

With its nearly 100 years of Pharmacy Rxpertise, VytlOne (formerly Maxor) is the nation’s only independent, fully integrated total pharmacy solutions partner.

Founded in 1926