Configuration Operations Specialist

Overview

As part of the Configuration Operations team at Free Market Health, the Configuration Operations Specialist will be responsible for research and operations support related to referral intake. As part of a growing team in a fast-paced, start-up environment, this position will support operational practices that deliver against key objectives to meet the needs of our internal and external stakeholders. Operational excellence will ensure both internal and external stakeholders' expectations are exceeded, and over time will support the company's efforts to drive growth through renewals and expansion.

This position is required to work onsite in our Pittsburgh (Strip District) office 5 days every week.

Specifics

The specific responsibilities for this role include, but are not limited to:

• Work daily auth issues stemming from:
  • OncoHealth intake
  • Manually submitting pharmacy and medical authorizations via csv file
  • Invalid or missing information on Opportunities
• Claims-based Intake
  • Research available UM systems to pull authorization details for missing authorizations
  • Submit requests through Client Services manager when UM access is not available
  • Create authorizations with details found to move Opportunities to Scope Assessor
• Run daily query for termed coverage claim rejects
  • Research member eligibility and update referral notes as necessary for Referral Operations
• Run member eligibility coverage checks on routine cadence for all active referrals when eligibility file is available
• Run query monthly against Payer active group listing provided by Client Services Manager
  • Run query to find all referrals associated with groups no longer active with payers
  • Look up member eligibility to confirm member did not switch to individual coverage
  • Update referral notes for Referral Operations so that treatments can be unmanaged
• Support Configuration Ops Manager as assigned to:
  • Research dosing schedules for medications
  • Configure drug OIDs for in-scope specialty drugs
  • Expand diagnosis OIDs
  • Research new drugs to market for limited distribution status and perform routine audit to update/maintain LDD records
  • Configure payer rates
  • Configure/update rate conversions
  • Configure new payer, drug and pharmacy information in proprietary technology systems, as necessary
• This position may occasionally be required to travel domestically (less than 5%)

Qualifications

• Associate's or Bachelor's degree in Business preferred
• 3+ years of work experience in healthcare, pharmacy benefit management, or pharma manufacturer hubs. Experience with specialty drugs is preferred. Knowledge of PA/UM process a plus.
• Demonstrated operational excellence in analytical thinking, process development and improvement, problem solving, communication, delegation, and planning
• Proficient computer skills with ability to learn proprietary company software
• Experience with Microsoft Office Suite
• Experience with SQL programming a plus

Location: Bloomfield, PA, US

Posted Date: 11/30/2024