Director of Business System Processing

General Description 

The Director of Business System Processing will play a pivotal role in the future of Equiscript. We are seeking a highly skilled and detail-oriented individual to lead and oversee critical business system processing functions within our TPA operations. This role involves ensuring seamless core processing across various domains, including EHR data ingestion and normalization, prescription claims management, drug pricing, and reference data loading, and Purchase Order EDI file operations. The ideal candidate will drive process improvement initiatives by gathering and documenting operational and system requirements, auditing complex processing chains, and collaborating with cross-functional teams to optimize application configuration for covered entities and pharmacies. Additionally, this position requires advisory support for client implementations, new customer file operations, and 340B program operations, alongside troubleshooting, data manipulation, forecasting, and report design. Partnering closely with the product team, the candidate will also contribute insights for enhancing business application requirements, ensuring efficiency and excellence in every aspect of TPA operations. 

This person will work together with developer teams, product managers, and business stakeholders/owners, collaborating with the pharmacy and client operations, sales and marketing, finance, human resources, and other internal support teams, as well as contributing to the overall vision for our annual product roadmap. 

This individual will need the ability to thrive in a small company where many responsibilities and demands may be called upon in the position, where flexibility, problem-solving skills, a positive attitude, and openness to career feedback to support rapid company growth.  

Key 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, which may include 

• 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. 

Professional Qualities 

• Flexible, organized, and detail-oriented with excellent critical thinking ability. 

• Strong written and verbal communication skills. 

• Exceptional presentation skills, both in-person and online 

Preferred Experience 

• 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 

Physical Requirements 

• Requires the ability to sit or stand for long periods, occasional stooping, and reaching; May require lifting up to 25 pounds; requires a normal range of vision and hearing with or without accommodations. 

• Occasional Travel may be required, to attend planning sessions, new product brainstorming, or requirements gathering 

Additional Information 

• Clear Background Check Required. 

Employment Information 

• Position Located is remote  

• Benefits include health plan, dental, vision, and paid time off. 

• Flex time. 

• 401k with a company match.