CVS Health logo
CVS Health

CVS Health is a leading healthcare company operating CVS Specialty, CVS Pharmacy, CVS MinuteClinic, and CVS Caremark. In 2018, CVS combined forces with healthca

Senior Manager, Pricing – Pharmacy Appeals

Location

Arizona + 2 moreAll locations: Arizona | Idaho | Vermont

Posted

3 days ago

Salary

$67.9K - $182.5K / year

Seniority

Senior

Bachelor Degree7 yrs expEnglish

Job Description

Senior Manager, Pricing – Pharmacy Appeals

CVS Health

• Lead a team colleagues and contractors in the management of pharmacy reimbursement appeals • Ensure appeals are executed under tight Turnaround Times (TATs) and with high accuracy • Develop and implement solutions to improve and automate processes • Coach the appeal team coordinators and guide other internal business units • Work with legal and compliance team to ensure state regulatory updates are operationalized • Counsel and mentor team members, providing guidance and support

Job Requirements

  • 7 year’s experience in pricing, PBM/healthcare operations, process improvement, quality, analytics, or related domains
  • 5+ years directly leading operations teams
  • 1+ years’ experience with pharmacy appeal related processes and state regulations, and claims adjudication, including claims adjudication logic
  • Proficient in Excel, MS Access, Salesforce, and Pharmacy Portal
  • Ability to work under tight deadlines
  • Strong mathematical problem-solving skills
  • Prior PBM Knowledge
  • Familiarity with wholesaler invoices
  • Bachelor’s Degree or equivalent experience required.

Benefits

  • medical, dental, and vision coverage
  • paid time off
  • retirement savings options
  • wellness programs

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