Specialty Pharmacy Payer Contracting Specialist

Heritage Specialty Pharmacy; Lee's Summit (MO); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a Strategic Accounts Analyst to drive contract negotiations and manage relationships with payers. This role is crucial for assessing payer contracts, addressing reimbursement challenges, and leading negotiations. The ideal candidate will collaborate with various departments, ensuring compliance with regulations while contributing to pharmacy-related projects. With a focus on strategic initiatives, this position offers the opportunity to impact the organization significantly. If you possess strong analytical skills, excellent communication abilities, and a passion for the healthcare industry, this role is perfect for you.

Qualifications

• 3+ years in contract negotiations with insurers/pharmacy benefit managers.
• Experience managing relationships with payers in specialty pharmacy.
• Understanding of managed care and pharmacy network concepts.

Responsibilities

• Lead contract negotiations and manage payer relationships.
• Analyze contracts for optimal reimbursement and coverage.
• Collaborate with teams to ensure compliance and education.

Skills

Contract Negotiation

Relationship Management

Analytical Skills

Problem Solving

Communication Skills

Time Management

Education

Bachelor's Degree

Relevant Experience

Tools

MS Excel

MS Word

PowerPoint

Job description

Job Description

Job Description

Strategic Accounts Analyst

The Strategic Accounts Analyst is responsible for developing, implementing, managing, negotiating and maintaining contracts and relationships with PBM and major medical payer networks. The Strategic Accounts Analyst will assess the value of each payer contract for Heritage Specialty Pharmacy, ensuring adherence to all contractual obligations. This role also involves addressing reimbursement challenges, evaluating network needs, and leading all contract negotiations. Additionally, the Strategic Accounts Analyst will contribute to various pharmacy-related projects and initiatives across all lines of business and geographic regions (Commercial, Medicare, and Managed Medicaid). Collaboration with multiple departments will be key to fulfilling the responsibilities of this role, including handling administrative tasks necessary to maintain compliance with state and federal regulations for retail, mail, specialty, and other pharmacy services. The Strategic Accounts Analyst will report to the Director of Client Management.

In this role, he/she will have access to sensitive company data, Protected Health Information (PHI) and Electronic Protected Health Information (EPHI).

Job Responsibilities and Essential Functions

• Leading managed care and payor contract procurement initiatives, including the support of payor contracting strategy.

• Contract renewals and contract reviews to determine substandard terms that need to be renegotiated.

• Collaborating with leadership, sales, and patient services teams to identify and pursue potential payor targets.

• Analyzing contracts to ensure appropriate coverage and negotiating for optimal reimbursement.

• Ensuring the successful implementation and ongoing operation of contracts by working with teams to educate on payor requirements, addressing questions, and monitoring for accurate reimbursement in collaboration with RCM team.

• Serving as the primary liaison between payors, other business partners, and the leadership team.

• Monitoring industry and payor trends to identify and pursue potential opportunities.

• Ensuring the ongoing maintenance of contracts by maintaining current portal profiles and responding to credential requests

• Negotiate pharmacy network reimbursement ethically in support of Heritage’s mission to meet or exceed clients’ expectations for all lines of business and programs: including Commercial, Medicare Part D, Managed Medicaid, Exchanges, Specialty, and Home Infusion Networks

• Negotiate and execute value-based care-specific contracts with insurers

• Work with clinical teams to identify possible quality measures applicable to services for each line of business

• Assist in the interpretation of data models to establish competitive market pricing to secure new/retained business

• Assist in the determination of network reimbursement pricing structures to align with organizational goals

• Review, recommend, and update insurer participation agreements and network addendums and effectively resolve contract issues

• Develop value proposition to payers for preferred, narrow, specialty, and limited distribution pharmacy networks

Required Qualifications

• Bachelor’s Degree or relevant experience.

• Three years or more experience in contract or rebate negotiations with insurers/pharmacy benefit managers on behalf of a specialty pharmacy

• Minimum of three years managing relationships with payers in a specialty pharmacy setting

• Experience with targeting and identifying contacts at insurers/pharmacy benefit managers for contracting opportunities

• Understanding of managed care, retail, and specialty pharmacy network concepts and PBM plan designs is highly desired

• Proficiency in MS Excel, MS Word, and PowerPoint. Soft Skills required for this position.

• Self-motivated with excellent written, verbal, and presentation skills.

• Excellent analytical and problem-solving skills that effectively implement solutions.

• Drive initiatives.

• Effective communication and interpersonal skills.

• Detail-oriented with a commitment to accuracy.

• Ability to work independently and collaboratively.

• Effective time management skills.

• Ability to resolve conflicts.

• Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.

• Dependability – trustworthiness and accountability are imperative in this role.

• Language Skills: Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents.

• Mathematical skills: Ability to solve simple math problems and analyze numbers as they relate to necessary job functions. Reasoning Ability: Define problems, collect data, establish facts, and draw valid conclusions.

• Soft Skills required for this position:

o Active Listening

o Live/Remote Presentation Skills

o Problem Solving

o Decision Making

o Adaptability

o Productively Working in a Remote Environment

Additional skills required:

o Multi-tasking, listening, teamwork, people skills, documentation skills, PC proficiency, organization, customer service, creating a safe and effective environment.

Preferred Qualifications

• Bachelor’s degree in applicable field

• 5 years managing relationships with payers in a specialty pharmacy setting

• 5 years or more experience in contract or rebate negotiations with insurers/pharmacy benefit managers on behalf of a specialty pharmacy

• Experience with targeting and identifying contacts at insurers/pharmacy benefit managers for contracting opportunities

Physical Requirements and Screenings

Physical Demands: The physical demands described here represent those that an employee must meet to perform the essential functions of this job successfully. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions.

• Must be able to lift and carry 20 pounds.

• While performing the duties of this job, the employee is regularly required to sit and talk or hear.

• The employee is frequently required to stand, walk, use hands or fingers to handle, or feel and reach with hands and arms.

• Specific vision abilities required by this job include close vision and ability to adjust focus.

Travel and Work Location

• This position is a remote role. As such, the employee is required to work and be available during regular business hours to allow for the highest level of collaboration with their team and other departments.

• Travel requirements:

o Travel as determined by leadership and required to execute job responsibilities listed above.

Hours: Monday-Thursday 8:00am-5:00pm CST, Friday 8:00am-3:30pm CST