Manager, Pharmacy Network Reimbursement
We’re building a new kind of pharmacy to cure one of our healthcare system’s most startling ills: over 50% of prescriptions are never picked up. Because staying on track with doctor’s orders requires more than just delivering pills, we’re managing everything from insurance logistics to pricing, late-night questions to supply chain, and anything else that could stand in the way of effective treatment. Our more than 700 employees are dedicated to fulfilling medicine’s true purpose: to improve the quality of life for everyone who needs it. We’ve filled over 1 million prescriptions to date. To aid our calling, we’ve raised $354 million in funding, and we’re on track to achieve $1 billion in annual recurring revenue (ARR) by 2021. Join us as we prove just how much a pharmacy can deliver.
About the Team
The Contract Reimbursement Team at Alto is searching for a Manager of Pharmacy Network Reimbursement to join us! Our team plays an integral role in ensuring that Alto maximizes our reimbursement and supports Alto’s mission and values. In this role you will work closely with our Legal, Finance, and Operations teams to provide network pricing analysis and reporting. You will become an expert in Alto’s claims process to generate insights on how we can optimize gross profit and margin, further enhancing how we provide world-class patient care. You will also play a crucial part of the PSAO contracting process, NCPDP claims, and the 835 process.
Accelerate your career as you:
- Monitor Direct and Indirect Remuneration, Administrative Fees, Contractual Adjustments and more from payers to determine reasonableness, investigate any unclear fees as needed
- Supports contracting development by identifying and communicating requirements necessary for contractual compliance and reimbursement enhancement
- Perform data analysis and interpretation using Business Intelligence tools. Prepare and report recommendations on key business initiatives and their financial impacts, including maximizing reimbursement
- Serve as a subject matter expert for revenue cycle management. Work closely with the Controller to enhance Alto processes and controls around 835 reconciliations, lockbox setup, etc.
- Work cross functionally with legal, finance, and operations to monitor open claims and ensure reimbursement compliance.
- Ensure all 3rd party claims are reimbursed according to contract terms
A bit about you:
Minimum Qualifications:
- Minimum 5 years of experience with PBM, Managed Care, Medicare, Medicaid contracts
- Knowledge of retail pharmacy reimbursement methodologies and terminology
- Understanding of NCPDP (National Council for Prescription Drug Programs) D.O. standards
- Understanding of PSAO (Pharmacy Services Administrative Organization) contracting
- Experience with Tableau/Looker or other data visualization tools
Preferred Qualifications:
- Accounting/Finance experience
Want to learn more about Alto? Check out our blog here: https://blog.alto.com
Alto Pharmacy is an Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status, or any other legally protected basis.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.