Insurance Verification Manager
The Manager, Reimbursement Services will effectively manage the reimbursement center in order to provide the highest level of service to patients and health care providers (HCP) to promptly identify and access prescription coverage (insurance, public payers, independent charities, and AbbVie programs) to enhance prescription fulfillment and assure that inbound and outbound calls and corresponding inquiries and issues are completed all in alignment with key performance indicators. This role will also drive continuous improvement initiatives for activities and products provided. Key Responsibilities Include:
- Manage day-to-day operations to deliver superior customer service and improved access to medication for commercial and uninsured patients.
- Monitor similar industry programs and regulatory guidance to ensure program relevance and compliance.
- Lead and mentor direct reports responsible for reimbursement operations for designated AbbVie products.
- Provide recommendations regarding appropriate promotional and business practices based on reimbursement capabilities.
- Develop and manage relationships with payors, providers, independent co-pay foundations, alternative funding outlets, etc. to increase the probability of prescription access and fulfillment.
- Partner with commercial teams within established guidelines and working relationships to ensure reimbursement center operations are aligned with consumer and professional marketing initiatives to create customer-focused operational efficiencies that maximize patient acquisition and retention.
- Understand and adhere to the Code of Business Conduct, Operating Guidelines as well as appropriate IRS, CMS, HIPAA, and OIG guidelines.
- Monitor productivity levels, identifying opportunities to optimize operational efficiencies and cost controls, develop and implement changes that will improve those efficiencies and the department's performance.
- Bachelor's Degree. Comparable or relevant experience will be considered.
- 2-4 years of experience managing reimbursement or call center is preferred.
- Minimum of 1-3 years in people management required.
- Knowledgeable of application regulations and standards affecting Pharmaceutical Products specifically knowledge of HIPAA guidelines and appropriate federal, state, and local regulations applicable to reimbursement and call center operations.
- Experience managing a reimbursement or call center is preferred.
- Experience working in retail/mail order/specialty pharmacy or related experience involved in the distribution, dispensing, and reimbursement of pharmaceuticals is preferred.
- Should possess a clear understanding of the pharmaceutical or healthcare business. Knowledge of federal healthcare programs, commercial payors/providers, managed care organizations and healthcare reimbursement is a plus.
- Pharmacy Operations Team, Commercial Brand Team, HCPs, Payors, Patients