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Overview
Mercalis is an integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Backed by proven industry expertise and results-driven technology, Mercalis helps navigate the complex life sciences marketplace by providing commercialization solutions to accelerate value and enhance patient lives.
Mercalis fosters a culture that encourages individuality and provides opportunities for creativity, growth, and success while fostering a team environment. We are a diversity-driven organization with an inclusive approach to delivering patient-centric solutions that, eliminate barriers for patients, and increase patient access to life altering medications.
The Program Supervisor is responsible for reimbursement and administrative supervisory work in the coordination of program services, quality assurance and personnel services within the department. Work involves the identification and implementation of program policies and procedures as directed by standard operating and program specific procedures. Work is performed with independent judgment, and action is reviewed by the Program Manager through conferences, reports, and observation of results obtained.
Responsibilities
• Responsible for performance management including but not limited to, coaching and mentoring subordinates, employee counseling, employee performance appraisals, conflict resolution and schedule adherence
• 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 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
• Identify and report pharmacovigilance information as required by client(s) (i.e., Adverse Events)
• 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.
• On time adherence to training deadlines for all corporate policies and procedures governing access to confidential data
• Ensure all SOPs are followed with consistency
• Conducts miscellaneous tasks or projects as assigned
Qualifications
• Bachelor’s degree and 2 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 4 years of reimbursement/insurance, healthcare billing, physician office, health insurance processing
• 3-5 years supervisory experience preferred with progressive levels of responsibility within a service driven environment
• Extensive knowledge of pharmacy benefit methodologies
• Extensive knowledge of Medicare, Medicaid, and private payer payment methodologies
• Initiative and strong work ethic critical
• Ability to lead within a fluid and dynamic environment
• Excellent problem-solving and decision-making skills required
• Attention to details
• Strong organizational and communication skills
