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Director, Reimbursements & Billing

Department: Finance
Location: New York, NY

Location: Remote (For Non-Local) or Hybrid (Local to NYC area)

Position Summary:

The Director of Billing and Reimbursements is a highly visible and critical position. In this role, you will collaborate with leadership, internal departments and department staff of both teams – billing and reimbursements within financial operations. This will include partnering on the pharmacy reimbursement process, client invoicing and the continued enhancement of our financial products for efficiencies, monitor KPIs and reporting.

Position Responsibilities:

  • Coach, mentor and drive successful operations in the reimbursement and billing team
  • Drive collection efforts to the client billing team to track collectability and escalate nonpayment issues to senior leadership
  • Support clinical programs upsell opportunities to include within billing parameters
  • Serve as key stakeholder in product roadmap discussions with strong execution
  • Develop controls as it relates to reporting to ensure accuracy
  • Maintain financial policies and procedures, monitors compliance with requirements
  • Lead key department activities as it relates to the overall financial operation this includes projects new business initiatives
  • Review data analysis and prepare report recommendations on key business initiatives
  • Drive continuous improvement within the finance organization to streamline processes and improve communication and flow of information to the business
  • Ad hoc projects as needed
  • Responsible for the adherence to the Capital Rx Code of Conduct including reporting of noncompliance

Minimum Qualifications:

  • 6+ years of management experience required
  • Prior Experience with PBM, and or health plan claims required
  • Understanding of retail pharmacy reimbursement methodologies and terminology
  • Undergraduate bachelor’s degree in Accounting, Finance, Business preferred or equivalent work experience
  • Ability to challenge and improve existing processes through automation and redesign
  • Motivated with the ability to work in a fast-paced, forward-moving environment
  • Proven track record of leading cross-functional initiatives, driving high performance, meeting deadlines, and executing on deliverables
  • Ability to balance multiple complex projects simultaneously
  • Exceptional written and verbal communication skills
  • Extremely flexible, highly organized, detail oriented, and able to shift priorities easily
  • Attention to detail & commitment to delivering high quality work product

Preferred Qualifications:

  • Contract management experience with PBM, Medicare, Medicaid preferred
  • Knowledge of NCPDP (National Council for Prescription Drug Programs) preferred
  • Experience or working knowledge data visualization tools recommended

Base Salary: $125,000 - $145,000

Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

About Capital Rx

Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nation’s electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B Corp™, Capital Rx is executing its mission through the deployment of JUDI®, the company’s cloud-native enterprise health platform, and a Single-Ledger Model™, which increases visibility and reduces variability in drug prices. JUDI connects every aspect of the pharmacy ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of pharmacy benefits and rebuilding trust in healthcare.

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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