Who We Are:
SmithRx is a rapidly growing, venture-backed Health-Tech company. Our mission is to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector by building a next-generation drug acquisition platform driven by cutting edge technology, innovative cost saving tools, and best-in-class customer service. With hundreds of thousands of members onboarded since 2016, SmithRx has a solution that is resonating with clients all across the country.
We pride ourselves for our mission-driven and collaborative culture that inspires our employees to do their best work. We believe that the U.S healthcare system is in need of transformation, and we come to work each day dedicated to making that change a reality. At our core, we are guided by our company values:
- Integrity: Our purpose guides our actions and gives us confidence in the path ahead. With unwavering honesty and dependability, we embrace the pressure of challenging the old and exemplify ethical leadership to create the new.
- Courage: We face continuous challenges with grit and resilience. We embrace the discomfort of the unknown by balancing autonomy with empathy, and ownership with vulnerability. We boldly challenge the status quo to keep moving forward—always.
- Together: The success of SmithRx reflects the strength of our partnerships and the commitment of our team. Our shared values bind us together and make us one. When one falls, we all fall; when one rises, we all rise.
Job Summary:
The Rebate Operations Manager will lead the end-to-end data lifecycle of our rebate programs. This role is responsible for the technical accuracy of claims submissions, the validation of payments against contract rates, and the recovery of "stale" or missed billing opportunities. You will serve as the primary link between our internal data and external partners, ensuring that our rebate revenue is captured fully and accurately at the NDC-11 level.
What you will do:
Claims Lifecycle & Quality Assurance
- Submission Management: Oversee initial claims file submissions and conduct comprehensive QA summaries to identify potential fallouts before submission.
- Error Resolution: Manage rejections from external partners; perform root-cause analysis on data issues and re-submit corrected claims to maximize capture.
- 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.
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.
- Invoice Verification: Marry billed amounts back to rate lists to identify missing, incorrect, or inappropriately billed amounts.
- Payment Reconciliation: Verify incoming payments against invoiced amounts; identify and dispute short-payments or missing funds.
Advanced Analytics & Forecasting
- Detailed Reporting: Build out rebate performance reports.
- Financial Estimating: Run monthly "pro-forma" estimates of expected rebates to serve as a benchmark for actual collections.
- Visual Data Strategy: Manage and optimize the internal dashboards to provide "slice-and-dice" visibility into rebate trends for executive leadership and sales teams.
What you will bring to SmithRx:
- 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
Originally posted on Himalayas