Sr Account Manager, Pharmacy

ABOUT THE ROLE: 

The Senior Account Manager will serve as a PBM subject matter expert operations resource for XO Health. The Senior Account Manager will work directly with the PBM vendor team to understand reporting and data needs, address business problems, and advance planned goals and strategy. The Senior Account Manager will collaborate with all departments within XO Health, most notably, customer support, operations, product, and finance to drive valued results and revenue for the company. 

RESPONSIBILITIES: 

• Day-to-day contact with PBM Account Managers including: ID Cards; Eligibility; Rx claims research/problem resolution; CRM issues tracking as it relates to PBM information or issues management; Rx Benefit consultation; and Rx Billing overview and assistance with PBM interactions.
• Track day-to-day issues related to clients’ pharmacy plans and assist team members in closing out open items.
• Escalate customer concerns that require intervention from management or other internal business units.
• Support the servicing of a designated book of business related to claims, reporting and administration.
• Support production of quality check quarterly report books for clients.
• Review data for reasonableness and validate data against key performance indicators collected from the Pharmacy Benefit Manager vendor (PBM).
• Interpret clients’ current pharmacy programs and identify/recommend gaps, alternatives, additional plan design changes, etc.
• Gather and translate customer business needs into service requirements.
• Assist in developing an implementation plan with client and serve as primary lead on PBM vendor implementation calls and meetings.
• Assist in the review of all agreements and/or documents related to best-in-class terms/provisions.
• Meet with clients in conjunction with Team or Company Leadership to review a) pharmacy utilization, b) abnormal utilization results, c) monthly claims experience, d) set strategies and goals.
• Research and understand industry trends and PBM product offerings.
• Maintain knowledge of and on applicable governmental compliance and regulations to educate and consult both client(s) and XO internal departments.
• Interpreting client changes reviewing change notices as they are distributed.
• Apply understanding of customers’ strategic plans and collaborate with internal partners.
• Train and educate other PBM Account Managers as needed.
• Potential travel for participation in business management meetings, and support of other business initiatives.

EXPERIENCE REQUIRED: 

The qualified candidate will have: 

• Bachelor’s degree in healthcare administration preferred.
• 5+ years of experience in related, progressive PBM account or customer management roles within a health plan.
• Demonstrate problem-solving skills and the ability to create and implement solutions.
• Advance knowledge of PowerPoint, Word, and Excel.
• Strong verbal and interpersonal communication, influencing, collaboration skills.
• Strong customer service skills, with the ability to develop strong client relationships.
• Ability to interact with vendors effectively.
• Excellent organizational and communication skills.
• Motivated self-starter who is also able to work well independently.
• Strong attention to detail.