Rebate Operations Manager
WFA Digital Insight
As the US healthcare system undergoes significant transformations, companies like SmithRx are at the forefront of change. With the rise of health-tech, demand for skilled rebate operations managers has grown substantially. According to recent trends, the healthcare industry has seen a 25% increase in health-tech investments, making this an exciting time to join the field. SmithRx stands out with its mission-driven culture and commitment to integrity, courage, and collaboration. With hundreds of thousands of members onboarded, the company is looking for a skilled professional to lead the end-to-end data lifecycle of its rebate programs. Before applying, candidates should be aware of the company's fast-paced environment and the need for strong analytical skills to drive business growth.
Job Description
About the Role
The Rebate Operations Manager is a critical position at SmithRx, responsible for leading the technical accuracy of claims submissions, validating payments against contract rates, and recovering missed billing opportunities. This role serves as the primary link between internal data and external partners, ensuring that rebate revenue is captured fully and accurately. As a key member of the team, the Rebate Operations Manager will work closely with various stakeholders to drive business growth and improve operational efficiency.The day-to-day responsibilities of this role will involve overseeing claims lifecycle and quality assurance, managing rejections from external partners, and conducting root-cause analysis on data issues. The ideal candidate will have a strong understanding of pharmacy benefit management practices, including utilization management and clinical program design.
What You Will Do
- Oversee initial claims file submissions and conduct comprehensive QA summaries to identify potential fallouts before submission
- Manage rejections from external partners and perform root-cause analysis on data issues
- Monitor and push for the billing of claims missed during initial windows due to vendor delays or data gaps
- Build and maintain master rate lists based on current formularies and utilization management
- Verify incoming payments against invoiced amounts and identify and dispute short-payments or missing funds
- Develop detailed reporting on rebate performance and run monthly pro-forma estimates of expected rebates
- Manage and optimize internal dashboards to provide visibility into rebate trends for executive leadership and sales teams
- Collaborate with cross-functional teams to drive business growth and improve operational efficiency
- Conduct financial estimating and forecasting to inform business decisions
- Ensure compliance with regulatory requirements and industry standards
What We Are Looking For
- Bachelor's degree in Finance, Accounting, Data Analytics, Economics, or Business Administration
- Minimum of 2 years of direct experience with a GPO or similar rebate aggregators/aggregating platforms
- Proficiency in managing large data sets at the NDC-11 level
- Advanced Excel skills and experience with data analysis and reporting
- Strong understanding of the reconciliation loop connecting initial claims to invoices, and invoices to actual cash received
- 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
- Excellent communication and interpersonal skills
- Ability to work in a fast-paced environment and adapt to changing priorities
Nice to Have
- Experience with data visualization tools and techniques
- Knowledge of programming languages such as Python or R
- Certification in data analytics or a related field
- Experience working in a health-tech company or similar industry
- Familiarity with cloud-based data management systems
Benefits and Perks
- Competitive salary and benefits package
- Opportunity to work with a rapidly growing health-tech company
- Collaborative and dynamic work environment
- Professional development and growth opportunities
- Flexible work arrangements and remote work options
- Access to cutting-edge technology and tools
- Comprehensive health insurance and wellness programs
- Generous paid time off and vacation policy
How to Stand Out
- Develop a strong understanding of data analytics and Excel skills to stand out in the application process
- Showcase your experience with rebate programs and pharmacy benefit management practices in your resume and cover letter
- Prepare to discuss your approach to data analysis and reporting, as well as your experience with stakeholder management
- Be ready to provide examples of your ability to work in a fast-paced environment and adapt to changing priorities
- Research the company culture and values, and be prepared to discuss how you align with them
- Practice your communication and interpersonal skills, as these are essential for success in this role
- Consider obtaining certifications in data analytics or related fields to enhance your career prospects
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