Account Manager - Payor Relations

Job Description

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 satisfaction
• Work 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 dispensing
• Assist 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 reports
• Review and analyze weekly shipped, non-admit, and discharge reports
• Assist admissions/PA with difficult patient cases
• Provide insight of changes within plans to sales, admissions, pharmacy, and billing departments
• Provide analysis of growth potential within each plan and a full region
• Assist 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 customers
• Provide analysis and support for VPs of Managed Care, Sr. Director of Contract Management and the SVP Trade
• Manage, review and follow up of pending contracts and provide support for timely completion, update contract files upon contract execution

Other Duties:

• Participate and perform other related duties as assigned by Leadership.

Competency:

• Strong knowledge of specialty pharmacy contracting, payor, PBM’s and managed care
• Must be able to meet time-sensitive deadlines and handle confidential and sensitive information appropriately
• Ability 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 procedures
• Strong 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 priorities
• Demonstrate excellent oral and written communication skills
• Strong networking skills
• Demonstrate proficiency in the use of MS Office software; which includes Excel, Word and Outlook
• Demonstrate the BioPlus C.A.R.T. values
  • Competence
  • Accountability
  • Respect
  • Trust

Qualifications

Qualifications

Education/Experience Requirements:

• Associate or Bachelor’s degree in healthcare related field preferred
• 3+ years of experience with Healthcare Plans or Specialty Pharmacy

Additional Information

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