Account Manager - Payor Relations

Posted 12 Days Ago
Be an Early Applicant
Altamonte Springs, FL
Mid level
Pharmaceutical
The Role
As an Account Manager for Payor Relations, you will manage payor relations, support contract implementation, analyze contracts, and ensure compliance with contract obligations. You will also serve as the primary contact for accounts, coordinate with internal stakeholders, and provide insights to facilitate problem resolution and client satisfaction.
Summary Generated by Built In

Company Description

As one of the largest and most respected specialty pharmacies, BioPlus creates a meaningful difference to our patients, prescribers, payers, and pharmaceutical partners.

Our 2 - Hour Patient Acceptance Guarantee gives a quick response to prescribers and patients for critical, time - sensitive treatments. As we continue to grow, we need exceptionally talented, bright, and driven people. If you would like to help us continue to be the innovative leader in our industry, this is your chance to join our team.

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

The Company
HQ: Altamonte Springs, FL
350 Employees
On-site Workplace
Year Founded: 1989

What We Do

Meet the premiere national specialty pharmacy backing up a ‘fast & easy’ promise with the Power of 2. Part of the CarepathRx family of pharmacy and medication management solutions, BioPlus Specialty Pharmacy offers a 2 Hour Patient Acceptance Guarantee™ so physician offices quickly know whether a referred patient is accepted for treatment. Then prescriptions are on their way with our 2 Day Ready 2 Ship™. Medication refills are an easy 2 clicks away for qualifying prescriptions.  

Similar Jobs

Verkada Inc Logo Verkada Inc

Regional Sales Manager, Mid-Market, Tampa

Cloud • Hardware • Security • Software
Tampa, FL, USA
2000 Employees
200K-230K Annually

Snap! Mobile Logo Snap! Mobile

Account Executive

Edtech • Fintech • Sports
Easy Apply
Tallahassee, FL, USA
300 Employees

ServiceNow Logo ServiceNow

GenAI Architect

Artificial Intelligence • Cloud • HR Tech • Information Technology • Productivity • Software • Automation
Hybrid
Orlando, FL, USA
26000 Employees

Affinitiv Logo Affinitiv

Account Manager - CRM/TiV (Automotive SaaS)

AdTech • Agency • Automotive • Marketing Tech • Social Media • Software • SEO
Easy Apply
Fort Lauderdale, FL, USA
500 Employees

Similar Companies Hiring

Novo Nordisk Thumbnail
Software • Pharmaceutical • Healthtech
Bagsværd, DK
69000 Employees
Zealthy Thumbnail
Telehealth • Social Impact • Pharmaceutical • Healthtech
New York City, NY
13 Employees
Cencora Thumbnail
Pharmaceutical • Logistics • Healthtech
Conshohocken, PA
46000 Employees

Sign up now Access later

Create Free Account

Please log in or sign up to report this job.

Create Free Account