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About the Role
The Systems and Integration Manager will manage, optimize, and improve the pharmacy management system, third-party integrations, and technology platforms for specialty pharmacy operations. This role acts as a liaison between pharmacy operations, IT, billing, and vendors to ensure technology supports business needs, regulatory requirements, and efficiency.
Responsibilities
- Serve as the primary business owner and subject-matter expert for the pharmacy management system.
- Maintain system configuration, workflows, business rules, protocols, queues, and user functionality.
- Evaluate system capabilities and identify opportunities to improve efficiency, accuracy, and scalability.
- Maintain system documentation, workflows, configuration specifications, and change history.
- Partner with IT and software vendors on system upgrades, releases, testing, and issue resolution.
- Manage and oversee the organization's transition to NCPDP F6 pharmacy claims standards.
- Develop and enforce standardized procedures for user provisioning, role assignment, access reviews, and termination workflows.
- Oversee periodic audits and validation of user permissions.
- Collaborate with Compliance, Information Security, and business stakeholders to define and maintain role-based access controls and system security standards.
- Design and implement automation solutions, alerts, and workflow enhancements.
- Analyze existing workflows to identify opportunities for automation and standardization.
- Monitor automation performance and adjust as business needs change.
- Own the pharmacy system support-ticket process and serve as the escalation point for system-related issues.
- Prioritize, investigate, and coordinate resolution of system issues with internal IT teams and external vendors.
- Track recurring issues and identify root causes and opportunities for permanent solutions.
- Establish appropriate escalation and communication processes for critical system issues.
- Monitor ticket trends and use data to identify opportunities for system improvements.
- Manage system enhancement requests from initial requirements through implementation.
- Serve as the liaison between pharmacy operations and technical teams, translating business requirements into system solutions and enhancement opportunities.
- Develop project plans, timelines, testing requirements, and implementation plans.
- Assess the operational impact of system changes and coordinate training and communication.
- Coordinate the implementation, configuration, testing, and maintenance of EDI transactions.
- Partner with payers, clearing houses, vendors, billing, finance, and IT to resolve EDI and transaction issues.
- Manage setup and troubleshooting of 835 Electronic Remittance Advice (ERA) files and related payment/reconciliation processes.
- Accountable for the design, configuration, implementation, testing, and ongoing support of 837 electronic claim transactions.
- Support implementation and maintenance of other electronic transactions, including eligibility, claims, acknowledgments, and remittance transactions.
- Validate transaction mapping and ensure data is accurately transmitted between systems.
- Troubleshoot rejected, missing, or incorrectly formatted transactions and coordinate resolution.
- Act as the bridge between pharmacy operations and technical teams.
- Communicate technical issues and solutions in a way that is understandable to non-technical stakeholders.
- Develop test plans and scenarios for system changes and enhancements.
- Conduct or coordinate regression testing following system updates.
- Ensure system changes support applicable pharmacy, payer, HIPAA, security, and regulatory requirements.
- Coordinate implementation and post-implementation monitoring.
- Coordinate user acceptance testing (UAT) and validate system functionality before production implementation.
Requirements
- Bachelor’s degree required. An additional four (4) years of experience will be considered in lieu of degree.
- Five (5) years of experience working in specialty pharmacy, healthcare IT, or with pharmacy management systems required.
- Experience configuring or administering pharmacy software is strongly preferred.
- Experience with EDI transactions and 835 files preferred.
- Understanding of pharmacy claims, billing, reimbursement, and payor processes.
- Strong understanding of specialty pharmacy workflows.
- Experience with system testing, workflow development, automation and implementation.
- Strong project and program management and organizational skills.
- Ability to work effectively with both technical and non-technical teams.
- Strong Microsoft Office skills required; experience with ScriptMed preferred.
- Excellent verbal, written and interpersonal communication skills.
- Proven examples of displaying the Reliance values: Collaborative, Accessible, Results-Oriented, Empowering, and Supportive.
Skills
- Pharmacy management system
- Third party integrations
- Technology platforms
- Specialty pharmacy operations
- EDI transactions
- 835 files
- Pharmacy claims
- Billing
- Reimbursement
- Payor processes
- Specialty pharmacy workflows
- System testing
- Workflow development
- Automation
- Implementation
- Project management
- Program management
- Organizational skills
- Microsoft Office
- ScriptMed
- Verbal communication
- Written communication
- Interpersonal communication
- NCPDP F6 pharmacy claims standards
- EDI transactions
- 837 electronic claim transactions
- Eligibility transactions
- Claims transactions
- Acknowledgment transactions
- Remittance transactions
Location
- Williamsville
Work Type
- Hybrid
Experience Level
- Five (5) years of experience working in specialty pharmacy, healthcare IT, or with pharmacy management systems required.
Education Level
- Bachelor’s degree required. An additional four (4) years of experience will be considered in lieu of degree.
Salary/Compensations
- $70,000 - $90,000 annually
Benefits
- Scorecard incentive
- Full range of benefits
- Generous paid time off
About the Company
- We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.
Equal Opportunity
- As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.