Specialty Pharmacy Payer Contracting Specialist

Heritage Specialty Pharmacy; United States; Remote; USD 80,000 - 85,000; Full time

Job summary

An established industry player in the healthcare sector is seeking a Specialty Pharmacy Payer Contracting Specialist. This pivotal role involves developing and negotiating contracts with major medical payer networks, ensuring compliance, and collaborating across departments. The ideal candidate will possess strong analytical and communication skills, with a proven track record in managing payer relationships. This full-time position offers a competitive salary and the opportunity to make a significant impact in a dynamic environment. If you're passionate about healthcare and ready to take your career to the next level, this role is perfect for you!

Qualifications

• 3+ years in contract or rebate negotiations with insurers/PBM.
• Experience managing payer relationships in a specialty pharmacy.

Responsibilities

• Lead managed care and payor contract procurement initiatives.
• Analyze and negotiate contracts for optimal reimbursement.
• Serve as the primary liaison with payors and partners.

Skills

Contract Negotiation

Analytical Skills

Problem-Solving Skills

Communication Skills

Detail-Oriented

Education

Bachelor’s Degree

Relevant Experience

Tools

MS Office

Job description

Specialty Pharmacy Payer Contracting Specialist

Join to apply for the Specialty Pharmacy Payer Contracting Specialist role at Heritage Specialty Pharmacy.

Salary Range

This range is provided by Heritage Specialty Pharmacy. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range: $80,000.00/yr - $85,000.00/yr

Job Overview

The Strategic Accounts Analyst is responsible for developing, implementing, managing, negotiating, and maintaining contracts and relationships with PBM and major medical payer networks. This role involves assessing contract value, addressing reimbursement challenges, and leading negotiations across all lines of business, including Commercial, Medicare, and Managed Medicaid. Collaboration with multiple departments is essential, and the role reports to the Director of Client Management.

In this role, access to sensitive data, PHI, and EPHI will be necessary.

Key Responsibilities

1. Leading managed care and payor contract procurement initiatives.
2. Managing contract renewals and reviews.
3. Collaborating with leadership and sales teams to identify payor targets.
4. Analyzing and negotiating contracts for optimal reimbursement.
5. Ensuring contract implementation and ongoing compliance.
6. Serving as the primary liaison with payors and partners.
7. Monitoring industry trends for opportunities.
8. Maintaining contract documentation and responding to credential requests.
9. Negotiating pharmacy network reimbursements ethically.
10. Negotiating value-based care contracts.
11. Working with clinical teams on quality measures.
12. Interpreting data models for market pricing.
13. Updating insurer agreements and resolving contract issues.
14. Developing value propositions for pharmacy networks.

Minimum Qualifications

• Bachelor’s Degree or relevant experience.
• At least three years in contract or rebate negotiations with insurers/PBM.
• Experience managing payer relationships in a specialty pharmacy setting.
• Proficiency in MS Office.
• Strong communication, analytical, and problem-solving skills.
• Detail-oriented and able to work independently and collaboratively.

Preferred Qualifications

• Bachelor’s degree in a related field.
• Five or more years managing payer relationships and negotiations.

Physical Requirements & Travel

Must be able to lift 20 pounds, sit, stand, walk, and use vision effectively. This is a remote role requiring availability during business hours and travel as needed.

Additional Details

Employment type: Full-time, Associate level, in the Healthcare industry.