Systems & Integration Manager

FIND YOUR FUTURE

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.

Overview

The Systems and Integration Manager will be responsible for the overall management, optimization, and continuous improvement of the pharmacy management system, third party integrations, and related technology platforms supporting specialty pharmacy operations. This role will serve as the primary liaison between pharmacy operations, IT, billing/reimbursement, vendors, and system third party vendors to ensure technology solutions effectively support business needs, regulatory requirements, workflow efficiency, and patient service.

The Systems and Integration Manager will lead system configuration, workflow development, automation, electronic data interchange (EDI), Open Refill File Transfer “ORTF” configuration, acceptance, and delivery, 835/payment file implementation, enhancement requests, issue resolution, and system-related projects. The role will identify opportunities to improve processes through technology with high ROI, while maintaining system integrity, data accuracy, compliance, and operational efficiency.

Qualifications

• 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.

Essential Accountabilities

• 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, including requirements gathering, system configuration, testing, vendor coordination, implementation, and ongoing pharmacy claims management support to ensure compliant and efficient claims processing.
• Develop and enforce standardized procedures for user provisioning, role assignment, access reviews, and termination workflows to ensure appropriate system access and data security. Oversee periodic audits and validation of user permissions, ensuring access remains aligned with job responsibilities and compliance requirements.
• 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 that improve operational efficiency and scalability. 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 between the pharmacy and external partners. 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 (837P, 837I, and applicable specialty pharmacy medical billing formats) to ensure accurate and compliant claim submission to payers.
• Support implementation and maintenance of other electronic transactions as applicable, 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 with appropriate parties.
• 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.

This is a hybrid position with onsite attendance required at our Williamsville location.

Immigration or work visa sponsorship will not be provided for this position

Hiring Compensation Range: $70,000 - $90,000 annually

Compensation may vary based on factors including but not limited to skills, education, location and experience.

In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.

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.

Current Associates must apply internally via the Job Hub.

The Independent Health Family of Companies, headquartered in Buffalo, NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in their health and well-being. Established in 1980, our comprehensive portfolio includes Pharmacy Benefit Dimensions, Reliance Rx, Nova Healthcare Administrators, Care for You and the Independent Health Foundation.

Our culture sets us apart. Our core values drive who we are and the work we do. As a member of our family, you’re part of something special, in your work and in the community.

We understand and appreciate that everyone has unique experiences, perspectives and identities which is why we pledge to create a safe space where all people and ideas are welcomed. We are here to continue learning and to generate important dialog.

We are committed to doing what matters most - reaching out, working together, and caring for our community. A healthy community benefits everyone who lives in it. You too can be part of making difference in the lives of others, together we achieve so much more. Please click here to view our Community Reports.

Apply today and join us on the journey to a happier, healthier, and more inclusive community.

We are committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans. An applicant for employment in need of an accommodation to participate in the application and recruitment process should contact Human Resources at: accommodations@independenthealth.com or Human Resources, 511 Farber Lakes Drive, Williamsville, NY 14221.

Please note, we do not accept unsolicited resumes. We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.