Payer Relations Manager

Meijer
parental leave
United States, Michigan, Grand Rapids
Nov 08, 2024
As a family company, we serve people and communities. When you work at Meijer, you're provided with career and community opportunities centered around leadership, personal growth and development. Consider joining our family - take care of your career and your community! Meijer Rewards Weekly pay Scheduling flexibility Paid parental leave Paid education assistance Team member discount Development programs for advancement and career growth Please review the job profile below and apply today! The Payer Relations Manager is responsible for managing and overseeing all aspects of pharmacy contracts, including negotiation, implementation, and compliance. Key responsibilities include reviewing and negotiating contract terms, monitoring contract performance, and ensuring compliance with all relevant laws and regulations. This role requires a deep understanding of the pharmacy industry, including drug pricing, reimbursement methodologies, and pharmacy benefit management. The successful applicant will be proactive and results-driven aiming to ensure the best outcomes for patients and customers. . What You'll be Doing: Draft, review, and negotiate pharmacy contracts. Accountable for all third-party related activities including but not limited to optimizing gross profit, payer contracting, billing, third party plan set-up, third party audits, MAC appeals, analytics, reporting, support for retail operations. Ensure compliance with regulatory requirements. Monitor contract performance and ensure compliance with terms and conditions. Develop and maintain relationships with key vendors and stakeholders. Analyze drug pricing and reimbursement methodologies. Provide guidance on contract-related issues to internal stakeholders. Conduct regular audits of contract compliance. Work closely with finance to ensure accurate billing and payment processes. Stay updated on industry trends and regulatory changes. Manage contract renewals and amendments. Develop and maintain contract templates and documentation. Develop and implement contract management policies and procedures. Resolve contract disputes and issues. Prepare reports on contract performance and metrics. Ensure timely execution of contracts. Maintain accurate records of all contract activities. Participate in cross-functional projects and initiatives. Provide training on contract management processes. Support the legal team in contract-related matters. This job profile is not meant to be all inclusive of the responsibilities of this position; may perform other duties as assigned or required. What You Bring with You (Qualifications): Bachelor's degree in Business Administration, or a related field or 5-to-7-year university or college degree with a Bachelor of Science in Pharmacy (pre-2001) or Doctorate of Pharmacy (post-2001) Minimum of 5 years of experience in contract management, preferably in the pharmaceutical industry. Strong understanding of pharmacy operations and regulatory requirements. Excellent negotiation and communication skills. Ability to analyze complex data and make informed decisions. Financial acumen. Strong analytical and problem-solving skills. Proven ability to manage multiple projects and meet deadlines. Experience with drug pricing and reimbursement methodologies. Knowledge of pharmacy benefit management. Attention to detail and accuracy. Ability to work independently and as part of a team. Strong organizational and time management skills. Experience with vendor management and relationship building. Knowledge of legal and compliance requirements related to pharmacy contracts. Leadership experience Ability to handle confidential and sensitive information. Strong leadership and decision-making skills. Proficiency in Microsoft Office Suite.