PBM Account Executive

AlignRx is a Public Benefit LLC (PBLLC)—a for-profit limited liability company that is intended to produce a public benefit and to operate in a sustainable manner. We are the only PSAO to establish itself as this type of legal entity, as we are deeply committed to promoting the interests of community pharmacies. You can count on us to be transparent, accountable, and passionate.

As an independently owned PSAO, we want community pharmacy owners to have maximum flexibility in their buy-side choices so they can maintain control over their business. AlignRx does not require pharmacy owners to purchase from a specific wholesaler or buying group. This benefit is just one more reason that community pharmacies experience peace of mind knowing our interests are in sync with theirs.

Our mission is to support community pharmacy by offering innovative products and services that are best in class and designed to promote the pharmacies we serve as essential healthcare providers resulting in improved patient care and outcomes.

Job Summary

Within the Payor Contracting Department, the PBM Account Executive is primarily responsible for managing contracted PBM and health plan relationships and supporting related internal business operations. This requires performing plan reviews, generating claims reports, analyzing claims data, reviewing contract terms, and performing other projects as assigned.. This position collaborates with the frontline Provider Relations team to serve AlignRx member pharmacies.

Essential Job Functions

• Serve as primary contact for assigned PBM accounts, addressing questions and resolving issues as they arise.
• Resolve payor contract related issues that come into customer service with PBMs to ensure timely follow-up and resolution.
• Manage PBM contracts, amendments, plan information, and other contract related documents.
• Manage the contract library and contract tracking log, as directed by management.
• Regularly update billing and claims processing (BIN/PCN) information database as updates become available.
• Draft pharmacy network communications for Payor Contracting management review and manage the communication request form process.
• Master knowledge of PBM contracts and provider manuals.
• Generate reports to validate PBM and health plan contract status/compliance.
• Generate rate models for contract/amendment analysis.
• Read and analyze PBM contracts as needed for ongoing contract compliance/management.
• Complete projects as assigned by AlignRx leadership.
• Draft policy and procedures for departmental functions.
• Organize and lead implementation meetings for new contracts for assigned PBMs.
• Oversee project management associated with contract implementation, as needed.
• Maintain high level knowledge of existing and newly launched AlignRx programs and services.
• Remain current on pharmacy industry trends and aware of AlignRx pharmacy member business needs and concerns.
• Interface and collaborate with Pharmacy Services, Clinical, Audit Assistance, Network Enrollment, Reconciliation Services, IT, and Finance for the purpose of issue resolution and defining efficient contracting processes.
• Create the annual Medicare landscape guide and other pharmacy resources, ensuring timely and accurate posting on the AlignRx Member Portal and internal circulation.
• Attend and actively participate in PBM Account Management team meetings and other videoconference meetings as assigned.
• Support affiliation of pharmacies to AlignRx chain codes, after a pharmacy member is fully onboarded and is experiencing contract access issues.

Minimum Qualifications for Consideration

• Four or more years’ experience as a pharmacy technician and/or job-related experience in retail pharmacy, PBM, or PSAO environment
• Prescription third party claims management experience
• Firm understanding of HIPAA compliance

Knowledge, Skills, and Abilities

• Excellent verbal and written communication skills
• Strong interpersonal skills: able to work and communicate effectively with all levels of co-workers, clients, and other external contacts
• Focused and driven, able to work independently with a high degree of excellence
• Strong organizational and time management skills
• Dependable with good attendance and adherence to timelines and schedules
• Strong analytical skills and attention to detail
• Good problem-solving skills
• Consistent follow-through on issue resolution
• Resourceful, with the ability to take initiative in development and completion of individual and team projects
• Strong sense of customer service
• Intermediate computer knowledge through effective use of a personal computer including Microsoft Office applications, specifically: file management skills, Microsoft Windows, database, word processing (Word), spreadsheets (Excel)
• Knowledge of and experience in the pharmacy and healthcare industry regarding terminology and retail pharmacy operations, including understanding of how and why pharmacy claims process (e.g., calculation of copayments, pricing hierarchies)
• Basic drug knowledge and understanding of Therapeutic Categories (TC), Multi-Source Indicators (MSI), Generic Product Identifier (GPI), Generic Code Number (GCN)

Physical Requirements/Working Conditions

• Sedentary work, requiring the following physical activities: sitting for long periods of time; occasional bending, squatting, kneeling, stooping; good finger dexterity and feeling; frequent repetitive motions; talking, hearing, and visual acuity
• Lifting of up to 20 pounds of paper supplies or minor office equipment
• Conducting work in a business-type environment (e.g., desk, table) that can facilitate the use of two computer monitors
• Remote

Direct reports

• None

Benefits

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

NOTE: The above statements are intended to describe the general nature and level of work performed by an employee in this position. These statements are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of employees in this position.

AlignRx is an equal opportunity employer and is committed to providing a workplace free from harassment and discrimination. We celebrate unique differences of our employees, knowing diversity drives innovation, and the success of our business. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, gender identity or expression, age, marital status, veteran status, disability status, pregnancy, parental status, genetic information, political affiliation, or any other status protected by applicable laws or regulations.

Pay: $49,000.00 - $55,000.00 per year

Experience:

• Pharmacy technician and/or retail pharmacy, PBM, PSAO: 4 years (Required)
• HIPAA compliance: 4 years (Required)
• Prescription third party claims management: 4 years (Required)

Work Location: Remote