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Moda Health Supervisor - Pharmacy Operations in Portland, Oregon

Supervisor - Pharmacy Operations

Job Title

Supervisor - Pharmacy Operations

Duration

Open Until Filled

Location

Portland,

OR

97204

Other Location

Description

Let’s do great things, together Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.

Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Moda is currently seeking Supervisor for our Pharmacy Operations. This role provides supervision of Medicare and Medicaid prior authorization coordinators, administrative, and claims processing staff. Organizes staff, set goals, ensures resources available as needed, coach and monitor team members to develop their skills, and knowledge in dealing with members, policyholders, brokers, providers, business partners and internal departments throughout Moda. Ensures all written and verbal correspondence is addressed promptly, professionally, accurately and courteously. Evaluates reports and results to ensure goals are achieved.

Primary Functions:

  • Address escalated verbal and written inquiries/complaints from members and providers, vendors, and other internal departments with responses that are professional, concise and accurate.

  • Apply knowledge of CMS and OHA regulation to accurately classify coverage requests and ensure adherence to turn-around time and uniformity requirements.

  • Oversee annual Policy and Procedure review for the PAC team, and revise policies as needed for mid-year changes.

  • Maintain and update PA letter templates in the PA processing system.

  • Monitor overall output and performance of the PAC team, ensuring deadlines and turn-around-time requirements are met.

  • Provide direction to team and keep them informed of expectations and performance in routine team meetings and 1:1s. Provides coaching and support to improve performance as needed.

  • Personnel administration, including timekeeping, performance appraisals, counseling, etc.

  • Assist with PA processing and auditing as needed when staff are on PTO.

  • Represent department leadership in cross-functional meetings both internally and with vendors.

  • Assist with creation and review of audit files, ad-hoc, and routine reports.

  • Consults with internal compliance department, clinical leadership, peers, vendors, or leadership as needed to quickly resolve compliance issues.

  • Responsible for overseeing implementation of business process updates related to efficiency or compliance. Evaluate and monitor changes and continue to modify processes as needed.

  • Generate adhoc reports from PBM and PA processing systems.

  • Perform other duties as assigned.

Are you ready to be a betterist? If you’re ready to make a difference that matters, we want to hear from you. Because it’s time to discover what’s possible. Together, we can be more. We can be better. Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.

Required Skills

  1. Bachelor’s degree preferred. Pharmacy Technician Certification required.

  2. Ability to work as needed to support PA processing team and department goals.

  3. 4+ years pharmacy benefit or pharmacy claim experience, in a retail, hospital, health plan or PBM setting.

  4. 2+ years’ experience processing Medicare and/or Medicaid Pharmacy PAs and claims.

  5. 2+ years’ experience leading or supervising a team.

  6. Familiarity with brand and generic drug names and medical terminology.

  7. Strong reading, writing, and verbal communication skills.

  8. Possess strong interpersonal skills necessary to deal with difficult issues and people; ability to lead diverse teams and consensus build without ostracizing individuals.

  9. Possess a strong understanding of different communication and work styles.

  10. Possess analytical, problem solving and decision-making skills.

  11. Proficiency with Microsoft Office applications, PBM processing systems, PA workflow management solutions and document repository systems required.

  12. Must maintain confidentiality and project a professional business presence and appearance.

  13. Must be able to work well under pressure with frequent interruptions, pressure to make compliant and timely decisions on problems resulting from phone calls, pressure of rapidly shifting priorities and the pressure of questions from many sources on many subjects.

  14. Ability to come into work on time and on a daily basis.

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