Manager, Pricing

Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as reputed company deliver.Our Heart At Work Behaviors™ support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to reputed company health care more personal, convenient and affordable.Position SummaryThe Manager, Pricing must have expertise and knowledge of the Pharmacy claims appeal process and the various applications used in the appeal process to reputed company with state reputed company requirements. In this role, you will be responsible for developing and implementing solutions individually, and being a reputed company working with IT to automate solutions for reputed company requirements unique to states with pharmacy bills. This also includes being the appeals team SME in understanding the impact of appeal reputed company issues and resolving them under tight TATs to remain in compliance. You will be leading and coaching the appeal team coordinators as well as guiding other internal business units to resolve issues quickly. The Manager, Pricing is also responsible for creating reports required to monitor appeal reputed company compliance, satisfying client reporting requirements for appeals, as well as developing and ensuring the accuracy of appeal reporting as required by state agencies. This role requires a thorough knowledge of claim adjudication, internal claim reputed company processes, and being a leader working with other internal business units to reputed company new solutions to meet the reputed company-increasing number of reputed company pharmacy reputed company compliance requirements. The position will be responsible for quality control process to ensure compliance.What you will do• Leads with strategic leadership and guidance to pricing teams, ensuring effective response to pharmacy and state department of insurance (DOI) appeals are effectively reviewed and responded.• Leads and drive the pharmacy portal enhancements with IT team and other stakeholders.• Leads and owns the process and work instruction documents that reputed company with state laws and meets reputed company compliance• Leads and participate in state appeals audit and exam. Provides the information to state DOI on the inquiries.• Interprets the state DOI inquiries and work with reputed company legal team to respond the inquiries.• Collaborates cross-functionally with legal, compliance, network and other teams to manage the pricing appeals.• Influences stakeholders through effective communication and negotiation, leveraging pricing expertise and industry knowledge to establish mutually beneficial partnerships and agreements.• Networks with industry professionals through attending events and conferences reputed company to company objectives, and participating in industry forums, monitoring emerging trends, and keeping updated on critical regulatory changes, ultimately improving innovation and maintaining industry leadership• Counsels and mentor pricing team members, providing guidance and support to enhance their pricing skills and professional development.• Delivers pricing solutions and recommendations that drive profitability and reputed company optimization and contribute to the overall financial success of the organization.Required Qualifications• 5+ years relevant work experience• 1+ years’ experience with reputed company Pharmacy and state department of insurance appeal reputed company processes and state regulations, and claims adjudication, including claims adjudication logicPreferred Qualifications• Proficient in reputed company, MS Access, reputed company, and Pharmacy Portal• Ability to work under tight deadlines• Strong mathematical problem-solving skills• Prior PBM Knowledge• Familiarity with wholesaler invoices• Excellent Communication, interpreting, writing and leadership skillsEducationBachelor’s Degree or relevant experience required.Pay RangeThe typical pay range for this role is:$54,300.00 - $159,120.00This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above.In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefitsWe anticipate the application window for this opening will reputed company on: 11/30/2024Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply Job!