PDP Contracts Administrator Remedi SeniorCare
THIS JOB HAS EXPIRED Reports to: CFO
Classification: Exempt Status
Compile, track, negotiate, renew and ensure compliance with contract terms of all PDP and Third Party Payor contracts.
Take primary responsibility for management of all payer and facility contracts. Ensure that Remedi has copies of all facility, PDP and third party payer contracts, contracts are current, and that pricing is well defined and consistent with required corporate standards.
Work with and build an effective relationship with MHA LTC Network contracting department. Ensure that we have copies and are complying with all agreements and provider manuals negotiated on our behalf by MHA. Work closely with MHA on contract renewals and be an advocate for Remedi as it relates to addressing reimbursement issues.
Organize, compile and maintain all payer contracts and create a data repository for the agreements.
Create and maintain a matrix that provides reimbursement rates for all PDP and third party payor contracts by pharmacy. Analyze contracts and identify variances by location and compare with current reimbursement rates, identifying differences and ensuring that Remedi is receiving proper level of reimbursement.
Formulate a pricing strategy. Develop and implement a negotiation plan with lower reimbursement providers to improve reimbursement rates, including a positive differential for Paxit.
Work closely with operations management to ensure that all changes in reimbursement, changes in PDP contracted rates, and changes in vendor costs are communicated promptly. Solicit from GMs ideas on cost reduction and incorporate into plan. Work closely with Legal Services regarding legal and regulatory compliance matters.
Bachelors? degree or four or more years of related work experience.
At least ten years experience with healthcare contracting, with a focus on insurance payers. Working knowledge of Medicare Part A and Part D programs. Demonstrated ability to compare reimbursement rates from multiple payers and identify areas to improve reimbursement.
Must be able to communicate effectively both verbally and in writing. Must have exceptional leadership skills with the ability to motivate and lead, strong problem solving abilities, and a strong customer service focus. Communication style that is both influential and persuasive.
Must be dependable with ability to be flexible, function independently and works under pressure with multiple tasks and deadlines. Must have strong organizational, time management skills, ability to problem solve. Proven ability to negotiate agreements.
Demonstrated organization skills. Proven ability to meet deadlines. Metrics driven. Detail orientation.
Ability to design, develop and implement effective processes. Must be a self starter.
Not currently part of this role, but expansion plans provide for the need of leadership skill to direct and manager a staff of professionals.
Contact with Others:
Some contact with employees. Frequent contact with payers and facilities requires effective Interpersonal skills exhibiting a pleasant out-going and caring attitude, the ability to interact positively with a professional attitude and demeanor.
This position will be exposed to highly confidential information and data that disclosed would be against Federal and State HIPPA law and contrary to the company?s policies and to professional ethics.
This position requires the ability to exert up to 40 lbs. of force occasionally and/or lift, carry, push or move objects.
Mental/ Visual Demands:
Flow of work requires normal mental and visual demands.
||Baltimore, MD |
THIS JOB HAS EXPIRED