Senior Manager, Pricing – Pharmacy Reimbursement Appeals

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🔥 0 minutes ago

🌵 Arizona – Remote

🌵 Arizona – Remote

💵 $75.4k - $166k / year

⏰ Full Time

🟠 Senior

💰 Pricing Analyst

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Lead a team of colleagues and contractors in the management of pharmacy reimbursement appeals • Ensure appeals are executed under tight Turnaround Times (TATs) and with high accuracy • Develop and implement solutions individually • Work with partners to improve and automate processes to increase productivity • Guide internal business units to resolve issues quickly • Collaborate with legal and compliance teams to ensure state regulatory updates are operationalized • Responsible for quality control processes to ensure compliance • Analyze competitive insights to generate actionable recommendations • Collaborate cross-functionally to align pricing strategies with business goals.

🎯 Requirements

• 7 year’s experience in pricing, PBM/healthcare operations, process improvement, quality, analytics, or related domains • 5+ years directly leading operations teams • 1+ years’ experience with pharmacy appeal related processes and state regulations, and claims adjudication, including claims adjudication logic • Excellent leadership skills • Proficient in Excel, MS Access, Salesforce, and Pharmacy Portal • Ability to work under tight deadlines • Strong mathematical problem-solving skills • Prior PBM Knowledge • Familiarity with wholesaler invoices • Bachelor’s Degree or equivalent experience required.

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families