About this role
Position Summary
Responsible for providing support in managing payor relations, program implementation, data feeds as contracted, and other contractual requirements. Provide analysis of contracts, facilitate internal company communication concerning payor clients, and manage payor contract requirements in order to maintain compliance and contract obligations.
Essential Functions:
Ensure accurate and timely completion of all assigned and contractual client requirements (reporting, application/contraction completion, presentation, monthly analysis).Serve as the primary contact for assigned accounts, interacting with client contacts to facilitate problem resolution and promote high client satisfactionWork directly with internal stakeholders including finance, IT, legal, operations, account management, contract management, sales and others to define requirements and support successful implementation and sales pull through on payor contracts.Maintain a current request for proposal (RFP) library, coordinate with stakeholders to maintain relevant and accurate information, develop RFP responses as approved by the executive team.Assist the Director of Contract Management with the business development process of contracting and executing new payor relationships.Work with other department, sales/account managers, pharmacy, billing, PCC’s and other departments to support company objectives.Engages targeted payors for contracts to allow pending patient dispensingAssist Credentialing Specialist as needed to complete enrollment applications/packages (Medicaid, Part D, MCO)Respond to questions surrounding contracts (reimbursement, benefit design, contracted services)Collate and create monthly, quarterly, and annual payor reportsReview and analyze weekly shipped, non-admit, and discharge reportsAssist admissions/PA with difficult patient casesProvide insight of changes within plans to sales, admissions, pharmacy, and billing departmentsProvide analysis of growth potential within each plan and a full regionAssist Hemophilia team (reimbursement, plan access, LOA, patient onboarding, etc.)Obtain Letter of Agreement when required for services (workmen’s comp/medical services)Announce drug formulary changes at a plan to internal customersProvide analysis and support for VPs of Managed Care, Sr. Director of Contract Management and the SVP TradeManage, review and follow up of pending contracts and provide support for timely completion, update contract files upon contract executionOther Duties:
Participate and perform other related duties as assigned by Leadership.Competency:
Strong knowledge of specialty pharmacy contracting, payor, PBM’s and managed careMust be able to meet time-sensitive deadlines and handle confidential and sensitive information appropriatelyAbility to work and lead in a team-oriented, collaborative environment.Excellent organization skills required and the ability to work on multiple accounts simultaneously.Maintains compliance with all BioPlus Specialty Pharmacy policies and proceduresStrong organizational skills with the ability to manage multiple work streams and implementation projects simultaneously.Ability to rapidly adapt and respond to changes in environment and prioritiesDemonstrate excellent oral and written communication skillsStrong networking skillsDemonstrate proficiency in the use of MS Office software; which includes Excel, Word and OutlookDemonstrate the BioPlus C.A.R.T. valuesCompetenceAccountabilityRespectTrust Qualifications
Education/Experience Requirements:
Associate or Bachelor’s degree in healthcare related field preferred3+ years of experience with Healthcare Plans or Specialty Pharmacy BioPlus offers competitive compensation packages including health care, 401(k), growth potential, and a challenging and exciting work environment.
BioPlus is an Equal Opportunity Employer