TECHNICAL OPERATIONS SPECIALIST LANSDALE, PA Looking for two candidates to fill two similar, yet slightly different roles on the same team. Please see difference in job description.
#1 - PBC Contract Set Up and Maintenance.
Contract Eligibility research and resolution.
340 Maintenance and Monitoring as extension with Integrichain.
Chargeback settlement communications with Customer as extension with Integrichain.
Pricing verification with 3PL, Wholesalers and Integrichain (to include meeting facilitation, Issue and Change management).
Rebate and Admin Fee Payment review and approval.
Amendment Management and Implementation support.
#2 - UBC Contract Set Up and Maintenance.
Plan Eligibility Maintenance and Audit.
Audit Support for Payment and Claims Reconciliation.
Formulary Validation.
Customer Issue Resolution as an extension of Integrichain.
Rebate and Admin Fee Payment review and approval.
Amendment Management and Implementation support.
Project Description:
CONTRACTING:
General Contracting Lead:
Oversight and management of contract lifecycles.
Collaborate with internal/external teams to create, implement, monitor, and measure contracts, amendments, and notifications.
Note: 30-day E2E from receipt of signed contract to implementation in the system.
Establish mailboxes, share drives, file share at both the Client and with IC as needed.
Manage documentation:
Work with Marc Rowe to ensure the migration of the signed and unsigned contracts and the rest of the Client's Share Drive folders and contents over to the Client.
Storage.
Naming conventions.
Permissions.
Total contracts: ~75 payor, ~150 provider.
Outline and train MA&AM on E2E process to guide the contracting collaboration between stakeholders.
Conduct quarterly reviews with IntegriChain.
Consider facilitating an annual review of contract performance with leaders from brands, operations, legal, account management, marketing, etc. To ensure that ROI is met.
Develop SOP and/or WI to reflect the role's processes.
IntegriChain Liaison:
Ensure mailboxes and file share are up and running.
Ensure manual tasks such as price protection and market share (e.G., ReUnite) calculations are documented in SOPs, validated, and can be supported.
Establish GoA if needed.
Determine if IC can accommodate tiered the Client's approvers.
Provide contracts to IC within 48 hours of signing.
Send to NewCoRebates@IntegriChain.Com.
Store on Share Drive.
Customer Membership and Eligibility Tasks:
Provide customer, membership, eligibility support.
Provide issue resolution support.
Approve credit / rebills for customer issues.
After contracts are signed reach out to the GPOs and their CME teams and introduce via email to IC to establish a relationship; then request their rosters go directly to IC; otherwise, you must forward them on a regular basis.
Chargeback and Wholesaler Tasks.
Determine effect of backorders/failure to supply on IC rebate payments; see Ken McDaid.
Provide issue resolution support.
Determine who approves chargeback errors; approve reconciliations; ensure the Client has decision rights on complex issues for compliance and audit purposes.
Contract Analyst Type Tasks (TBD).
Ensure government contracts set up and running appropriately (Medicaid, State, 340B, FSS, TriCare, VA, DoD).
Ensure IC is ready to go with market share, and other calculations; inform Compliance of work going on outside the system.
Review and approve contract set up term sheets created by IC including bundles and/or stacking.
Review and approve price protection.
Review and approve utilization and other customer data.
Review and approve payments and packages/documentation (within 48 hours).
Establish standing meetings, weekly then monthly then quarterly with IC.
Notify IC of any/all price changes right away.
Systems.
Support testing when needed of new/changed contracts, price protection; start w/basics CBs, Fees, REB, Scrubbing, then more complex items like MS, F2S; test SOPs.
Support contract related testing prior to and post Spin between stakeholders as needed on systems, apps, tools and processes.
Support IC, IT and other areas of the Client with testing of systems, apps, tools and processes as needed.
Data and Reporting.
Determine reporting needs across MA&AM team; coordinate with IC to either leverage existing reports, create new, or leverage analytics platforms.
Identify a single POC for reporting to avoid duplication, control number of users/licenses.
IC provides iCyte (wholesaler data) and SiSense analytics platforms.
IC provides 5 basic reports in the current SOW.
Note: data is deduped; not double paid.
This 12+ month position starts ASAP.
Please E-MAIL your resume (attachment to email) with rate and availability to Jennifer: jennifer@alphaconsulting.Com
ALPHA'S REQUIREMENT #23-00334
MUST BE ELIGIBLE TO WORK IN THE U.S. AS AN HOURLY W2 EMPLOYEE
