• Humana
  • $99,100.00 -169,950.00/year*
  • Springdale , AR
  • Accounting
  • Full-Time
  • 1319 Rogers Ave


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Description

The Channel Development Professional 2 within the Payer Contracting Team works to solicit network contracts for all Pharmacy lines of business. Provides management reporting and expertise to maximize network agreements, improving sales performance and increase prescription volumes. Identifies key areas of improvement through feedback received through contracting efforts. Understands department, segment, and organizational strategy and operating objectives including their impacts to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Responsibilities

Responsibilities

* Initiates network contracting requests to expand Specialty contracts, completing documentation as required to meet payer requirements
* Contracts directly with secondary plans to support existing Pharmacy business
* Completes re-credentialing/re-validation for lapsing agreements
* Completes notification and/or re-contracting with change of control or rebranding.
* Engages with pharmacy personnel and plan help desks to resolve claim denials because pharmacy is listed \\\"out of network\\\"
* Identifies plans in regional/geographical area to pursue contracting from both a retail and specialty contracting perspective
* Leverages CMS \\\"any willing provider\\\" rules to obtain network access and will leverage state \\\"AWP\\\" rules as needed to get contracting opportunities
* Maintains contracting sharepoint and related trackers
* Completes analysis on network landscape
* Completes other duties as assigned
* Works with strategic groups to complete RFI/RFP Requests
* Collaborates with legal, licensure, and payment groups to maintain documentation required for the maintenance of contracts

Required Qualifications

* Bachelor's degree or equivalent experience
* 4+ years of experience in a pharmacy setting
* Experience in claim adjudication
* Understanding of pharmacy and medical benefits relating to pharmaceuticals
* Strong communication skills both oral and written
* Brings an organized, attention-to-detail approach to work

Preferred Qualifications

* Specialty Pharmacy experience
* Network Contracting Experience
* Medical billing for pharmaceuticals

Additional Information

Scheduled Weekly Hours

40

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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