Payor Contracts Specialist

Reposted 16 Days Ago
Be an Early Applicant
Laguna Hills, CA
In-Office
Mid level
Healthtech
The Role
The Payer Contract Specialist manages payer contracting, ensures access and reimbursement, analyzes performance, and collaborates across teams to optimize outcomes.
Summary Generated by Built In

About AmeriPharma

AmeriPharma is a rapidly growing healthcare company where you will have the opportunity to contribute to our joint success on a daily basis. We value new ideas, creativity, and productivity. We like people who are passionate about their roles and people who like to grow and change as the company evolves.

AmeriPharma’s Benefits

  • Full benefits package including medical, dental, vision, life that fits your lifestyle and goals
  • Great pay and general compensation structures
  • Employee assistance program to assist with mental health, legal questions, financial counseling etc.
  • Comprehensive PTO and sick leave options
  • 401k program
  • Plenty of opportunities for growth and advancement
  • Company sponsored outings and team-building events
  • Casual Fridays 

Key Responsibilities:

  • Contract Negotiation and Management:
    • Negotiate, review, and execute payer contracts for pharmaceutical products, ensuring favorable terms and conditions for the company.
    • Manage the full contract lifecycle, from initial negotiation to renewal and termination.
    • Analyze contract performance and identify opportunities for improvement.
    • Ensure compliance with all relevant laws, regulations, and company policies.
  • Market Access and Reimbursement:
    • Monitor changes in the payer landscape, including policy updates, formulary decisions, and reimbursement trends.
    • Develop and implement strategies to optimize market access and reimbursement for new and existing products.
    • Collaborate with internal stakeholders (e.g., sales, marketing, legal, finance) to support market access initiatives.
  • Data Analysis and Reporting:
    • Track and analyze key performance indicators (KPIs) related to payer contracts and market access.
    • Prepare regular reports on contract status, performance, and market access trends for management.
    • Utilize data to identify areas for strategic focus and improvement in payer relations.
  • Relationship Management:
    • Build and maintain strong relationships with key payer contacts and stakeholders.
    • Serve as a primary point of contact for payer-related inquiries and issues.
    • Represent the company at industry conferences and meetings as needed.
  • Cross-Functional Collaboration:
    • Work closely with legal counsel to ensure contract compliance and mitigate risks.
    • Collaborate with finance to assess financial implications of contract terms.
    • Partner with sales and marketing teams to support product launch strategies and market penetration.

Qualifications:

  • Bachelor's degree in business, healthcare administration, finance, or a related field. Master's degree preferred.
  • 3+ years of experience in payer contracting within the pharmaceutical or healthcare industry.
  • Proven track record of successful contract negotiation and management.
  • In-depth knowledge of managed care organizations, commercial payers, Medicare, and Medicaid.
  • Strong understanding of pharmaceutical reimbursement methodologies and market access strategies.
  • Excellent analytical, negotiation, and communication skills (written and verbal).
  • Ability to work independently and as part of a team in a fast-paced environment.
  • Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint).

Preferred Qualifications:

  • Experience with specialty pharmacy and/or infusion therapy preferred.
  • Proven experience in managing relationships and negotiating with health plans, PBMs, and other payer organizations.

AmeriPharma’s Mission Statement 

Our goal is to achieve superior clinical and economic outcomes while maintaining the utmost compassion and care for our patients. It is our joint and individual responsibility daily to demonstrate to outpatients, prescribers, colleagues, and others that We Care!

    Physical Requirements 

    The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is continuously required to sit and talk or hear. The employee is occasionally required to stand; walk; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and stoop, kneel, crouch or crawl. The employee must regularly lift and/or move up to 20 pounds and occasionally lift/or move up to 30 pounds. Specific vision abilities required by this job include close vision, peripheral vision, depth perception and the ability to adjust focus.

    EEO Statement 

    The above statements are intended to describe the work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required. The duties and responsibilities of this position are subject to change and other duties may be assigned or removed at any time. AmeriPharma values diversity in its workforce and is proud to be an AAP/EEO employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, sexual orientation, gender identity, national origin, age, protected veteran status, or based on disability or any other legally protected class.

    Top Skills

    Microsoft Office Suite
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    The Company
    HQ: Orange, CA
    101 Employees
    Year Founded: 2006

    What We Do

    AmeriPharma has three distinct divisions: Specialty Care, Infusion Center, and MedBox.

    SPECIALTY CARE
    AmeriPharma Specialty Care operates within the highest standards of the industry, receiving the recognition and accreditation from the Accreditation Commission for Health Care (ACHC) and URAC. Pharmacists and specialists collaborate with doctors, manufacturers, and insurance companies to provide patients with full-service support.

    INFUSION CENTER
    AmeriPharma Infusion Center offers resort-style infusion therapy that combines comfort and convenience. The state-of-the-art facility serves patients IV medication therapies while being under the personal care of experienced registered nurses and a licensed oncologist.

    MEDBOX
    AmeriPharma MedBox is an innovative medication packaging system intended for patients taking multiple medications. Prescriptions are filled, sorted by the dose, and delivered to the patient’s door at no additional cost.

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