Senior Specialist, Payor Performance

at  Shoppers Drug Mart Pharmaprix

Referred applicants must not apply directly to this role. All referred applicants must use their unique referral link generated when they are referred by an existing colleague.

SKILLS AND EXPERIENCE:

• A minimum of 2-4 years’ experience in data analytics or Pharmacy/Healthcare setting, preferably in a retail, private payor, or audit environment
• Undergraduate degree required, a degree in Healthcare/Analytics/Business would be considered an asset. PMP certification is also an asset.
• Strong analytical technical skills and proficiency in:
• Data analysis tools (e.g., Excel, SQL, Python, etc.)
• Data visualization tools (e.g., Power BI, etc.)
• Data management tools (e.g., MySQL, SAP, etc.)
• Statistical programming languages (e.g., R, Python, etc.)
• Advanced understanding of Third Party Payor drug plans, adjudication, and processes is an asset
• An understanding of pharmacy regulatory requirements, CHLIA guidelines, and CPhA Pharmacy Claim Standard is an asset
• Advanced level of initiative and judgment to organize and prioritize tasks, workload, and projects to meet required deadlines amid competing demands
• Advanced Microsoft Office skills: Excel, PowerPoint, Word to produce reports, documents, and presentations
• Pharmacy Management System experience considered an asset (e.g., KROLL, HealthWATCH)
• Strategic thinker with exceptional problem-solving skills and ability to develop innovative solutions to complex problems.
• Utilize decision making skills to determine the best use of resources and operational processes
• Solid interpersonal skills and a collaborative style; comfortable dealing with all levels of management
• Strong collaboration, presentation, and excellent verbal and written English communication skills

DUTIES AND RESPONSIBILITIES:

• Develop and execute the Payor Performance team’s goals and objectives by streamlining Third Party Payor processes via risk management analysis and risk assessments
• Develop an extensive understanding of Third Party Payors in relation to adjudication issues, pharmacy manuals and processes
• Developing databases and enhancing visibility to Third Party remittance data via an advanced understanding of analytics and building payor relationships
• Collaborate with cross-functional teams to design, develop, and maintain data models, reports, and dashboards that meet the Enterprise’s needs
• Lead complex data analysis projects, applying advanced statistical techniques and data modelling methods to drive business insights and recommendations
• Identify strategic gross margin initiatives by Province and Payor and conduct detailed analysis to support initiatives including the analysis of audit risk and recoveries and the identification of potential regulatory, financial or policy risk
• Drive insights and recommend a risk management approach to reduce financial impact to stores
• Support stores during the entire end-to-end Payor process, including adjudication and appeals, knowledge sharing initiatives to guide stores on best practices and tracking results to generate reports and insights
• Make recommendations based on Third Party Payor Provider Agreements, and Pharmacy Manual policies/procedures to reduce financial risk
• Develop and maintain external relationships with select Third Party Payor Teams to support stores and field resources during processes
• Monitor team shared mailbox and respond to escalations accordingly

TYPE OF ROLE:

Regular
Shoppers Drug Mart Inc. recognizes Canada’s diversity as a source of national pride and strength. We have made it a priority to reflect our nation’s evolving diversity in the products we sell, the people we hire, and the culture we create in our organization. Accommodation is available upon request for applicants with disabilities in the recruitment and assessment process and when hired.
In addition, we believe that compliance with laws is about doing the right thing. Upholding the law is part of our Code of Conduct – it reinforces what our customers and stakeholders expect of us.