The Manager, Payor Contracting & Network Development is responsible for effectively managing strategic payer relationships and ensuring the successful negotiation and execution of contracts.
Requirements
- Develop sincere business relationships with payers, advocate for mutual interests and ensure the organization’s best interests are advanced.
- Engage strategically with payers to foster associations that advance AmeriPharma's community commitments.
- Lead the drafting, negotiation, and execution of payer contracts to ensure favorable and equitable terms for AmeriPharma.
- Monitor financial performance across payer contracts, ensuring compliance, maintaining fairness and consistency across all payer agreements, and identifying areas for improvement or adjustment.
- Maintains organizational documents for educating appropriate subsidiaries on managed care contracts, including but not limited to contract databases and matrixes.
- Facilitates problem solving of escalated contractual, payer policy and operational issues through collaboration with managed care organizations and internal stakeholders.
- Collaborate with practices to develop effective payer contracting strategies that optimize network access and reimbursement.
- Guide practices through contract negotiations, providing support and expertise to achieve beneficial outcomes.
- Coordinate with various internal teams to assess the impacts of payer contracts on different divisions.
- Manage contract-related challenges and opportunities within assigned areas.
- Serve as a subject matter expert on pharmacy and medical contracting including but not limited to managed care; specialty, long-term care, and home infusion networks; Pharmacy Service Administration Organizations (PSAOs); Pharmacy Benefit Management (PBMs) and other relations.
- Ensure that contracts meet all regulatory requirements and incorporate effective strategies for dealing with payer-specific policies.
- Contribute to the strategic direction of payer contracting, ensuring contracts align with company goals and market demands.
- Stay informed on industry trends, regulatory changes, and payer-specific policies that could affect contract performance, and enhance awareness within the organization’s business models.
- Communicate policies and procedures clearly to payers, addressing inquiries confidently to ensure clarity and efficiency.
- Stay informed on healthcare market trends, proposing strategic adjustments to contracts to enhance AmeriPharma's market position.
- Analyze financial data to inform decision-making and contribute to leadership discussions.
- Ensure the accurate creation and documentation of all payer contracts, synthesizing complex information into clear and concise contract terms.
- Present complex contract terms and performance data in a professional and understandable manner to internal stakeholders.
- Oversee contract performance and compliance through detailed reporting and regular evaluations.
- Demonstrate knowledge of payment methodologies for commercial and government payers, aligning departmental processes accordingly.
- Lead and oversee payer contracting projects and coordination efforts within the organization for new contract opportunities, risks, and challenges, ensuring goals are met and the organization’s objectives are supported.
- Maintain a working knowledge of government healthcare plans and advocate for effective contracts within those frameworks.
- Understand commercial insurance models, incorporating insights into contract negotiations to ensure effectiveness.
- Represent AmeriPharma with confidence and enthusiasm, establishing credibility in all payer discussions.
Benefits
- Full benefits package including medical, dental, vision, life that fits your lifestyle and goals
- Great pay and general compensation structures
- Employee assistance program to assist with mental health, legal questions, financial counseling etc.
- Comprehensive PTO and sick leave options
- 401k program
- Plenty of opportunities for growth and advancement
- Company sponsored outings and team-building events
- Casual Fridays
