Payer Relations Contracting Specialist

Overview

The Payer Relations Contracting Specialist is responsible for managing and optimizing contracts with third-party payers (insurance companies, PBMs, CMS) for pharmacy services.

• Bachelor’s degree in Business Administration, Healthcare Management, or related field desired

• 2+ years of experience in contract management
• Strong understanding of payer contracts, healthcare reimbursement processes, and relevant regulations
• Excellent analytical, communications, and interpersonal skills
• Proficiency in Microsoft Office Suite, particularly in Excel and Word

• Sense of urgency
• Organized, detail-oriented, catches errors early
• Ethical; respects confidentiality

• Ensure timely execution of contracts.
• Maintain accurate records of all contract activities.
• Manage contract life cycles, renewals and amendments.
• Conduct regular audits of contract compliance with applicable laws, regulations, and company policies.
• Collaborate with internal teams, including pharmacy operations, finance, and legal, to ensure effective contract management.
• Provide guidance on contract-related issues to internal stakeholders.
• Identify and mitigate potential risks associated with payer contracts.
• Resolve contract disputes and issues.
• Maintain contract continuity through performing required credentialing with payers.
• Support the legal team in contract-related matters.
• Develop and maintain contract templates and documentation.
• Develop and implement contract management policies and procedures.
• Participate in cross-functional projects and initiatives.
• Stay up to date on industry trends and regulatory changes related to payer contracts.

• Fast-paced environment.
• Requires normal vision (corrected) both close and distant.
• Requires normal hearing levels (corrected).
• Requires working at a desk to use a phone and computer for extended periods of time. Requires sitting, bending.
• Works effectively with frequent interruptions.