SmithRx - Rebate Operations Manager

• Claims Lifecycle & Quality Assurance • Submission Management: Oversee initial claims file submissions and conduct comprehensive QA summaries to identify potential fallouts before submission. • Submission Management: • Error Resolution: Manage rejections from external partners; perform root-cause analysis on data issues and re-submit corrected claims to maximize capture. • Error Resolution: • Stale Billing Recovery: Monitor and "push" for the billing of claims missed during initial windows due to vendor delays or data gaps, ensuring no revenue is left on the table. • Stale Billing Recovery: • Financial Integrity & Rate Maintenance • Rate List Development: Build and maintain master rate lists based on current formularies and utilization management (UM) to correspond with product-specific rates. • Rate List Development: • Invoice Verification: Marry billed amounts back to rate lists to identify missing, incorrect, or inappropriately billed amounts. • Invoice Verification: • Payment Reconciliation: Verify incoming payments against invoiced amounts; identify and dispute short-payments or missing funds. • Payment Reconciliation: • Advanced Analytics & Forecasting • Detailed Reporting: Build out rebate performance reports. • Detailed Reporting: • Financial Estimating: Run monthly "pro-forma" estimates of expected rebates to serve as a benchmark for actual collections. • Financial Estimating: • Visual Data Strategy: Manage and optimize the internal dashboards to provide "slice-and-dice" visibility into rebate trends for executive leadership and sales teams. • Visual Data Strategy: • internal dashboards • Bachelor’s Degree: Finance, Accounting, Data Analytics, Economics, or Business Administration. • Minimum of 2 years of direct experience with a GPO or similar rebate aggregators/aggregating platforms is highly preferred. • Proficiency in managing large data sets at the NDC-11 level. Advanced Excel is required. • Strong understanding of the "reconciliation loop" connecting initial claims to invoices, and invoices to actual cash received • A proven ability to track "Stale Billing" and "Post-Billing Rejects" through to resolution. • Proven knowledge of pharmacy benefit management practices, including UM and clinical program design. • What SmithRx Offers You: • Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance • Flexible Spending Benefits • 401(k) Retirement Savings Program • Short-term and long-term disability • Discretionary Paid Time Off • Paid Company Holidays • Wellness Benefits • Commuter Benefits • Paid Parental Leave benefits • Employee Assistance Program (EAP) • Well-stocked kitchen in office locations • Professional development and training opportunities