Director Of Business System Processing

Summary

Join Equiscript as the Director of Business System Processing and play a pivotal role in shaping the future of our TPA operations. Lead and oversee critical business system processing functions, ensuring seamless core processing across various domains, including EHR data ingestion, prescription claims management, and more. Drive process improvement initiatives, gather and document requirements, audit processing chains, and collaborate with cross-functional teams. Provide advisory support for client implementations, new customer file operations, and 340B program operations. Partner with the product team to enhance business application requirements. This role requires flexibility, problem-solving skills, and a positive attitude in a fast-paced environment. The position is remote with benefits including health, dental, vision, paid time off, flex time, and a 401k with company match.

Requirements

• Flexible, organized, and detail-oriented with excellent critical thinking ability
• Strong written and verbal communication skills
• Exceptional presentation skills, both in-person and online
• Clear Background Check Required

Responsibilities

• Assume responsibility for all business system processing functions, including monitoring file loading and export operations, monitoring batch processing dashboards, and ensuring smooth operations of our core TPA processing
• EHR data ingestion, cleaning, and normalization
• Processing prescription claims with business rules
• Loading drug price files and related reference data
• Loading Purchase order EDI files
• Responsible for leading process improvement initiatives by gathering and documenting operational business and system requirements, together with business and systems analysts
• Understanding, documenting, periodic audit of, and overseeing the complete processing chain and dependencies, including application configuration and setup for covered entities and pharmacies, together with internal pharmacy setup and CE configuration teams
• Provide advisory support for Client implementations and requirements gathering, which may include: recommendations for eligibility models, claims processing logic options, invoicing process, or support with report requirements gathering
• Provide oversight of new customer file operations and ingestion, which includes providing and analyzing file requirements, CE data quality, and CE data processing hyper-care during new implementations, EHR conversions, supporting client M&A activity or re-implementations
• Providers advisory support for 340B program operations across the company as needed, including on new product development, new customer implementation support, new efficiency initiatives, or when attaining industry certifications such as HI-trust
• Partner with the product team to provide recommendations for business application requirements
• Provide the ability to troubleshoot, investigate, and execute complex business data-related tasks including manipulation of data, providing basic economic forecasts, and design reports

Preferred Qualifications

• Bachelor’s degree and 10+ years of pharmacy or healthcare industry experience; Master's degree preferred
• 3+ years of 340B operations or compliance experience preferred, including leading QI efforts or EMR efforts in support of 340B or TPA operations
• Demonstrated ability to lead complex business system operations, new product launches, and/or large-scale transformational initiatives
• Technical or scientific background preferred; experience with technical product management and/or Agile development methodology helpful
• Excellent interpersonal skills including such areas as team spirit, problem resolution, collaboration, pitching in where needed, valuing and respecting individuals irrespective of seniority levels
• Proven track record of improving business system processing operations

Benefits

• Health plan
• Dental
• Vision
• Paid time off
• Flex time
• 401k with a company match