Sr. Specialist, MID Payer Services & Accreditation
$105,500–$175,900 year
RemoteTexas, United States
Job Summary
Guide practices through URAC, ACHC, and other accreditations while developing and maintaining continuous quality improvement programs. Act as a consulting advisor to optimize patient access, build plan sponsor partnerships, and develop contracting strategies for network access and reimbursement. Assist with integration of accreditation requirements, contract negotiations, and long-range contracting strategies to enhance patient advocacy. This role requires 7+ years of pharmacy contracting and accreditation experience, with 3+ years in practice consulting. Base pay ranges from $105,500 to $175,900. Candidates must be able to travel up to 40% of the time.
Required Qualifications
- Bachelor's Degree or equivalent experience
- 7+ years pharmacy contracting, pharmacy quality improvement, and/or pharmacy regulatory and payer compliance
- 3+ Years of experience with URAC or ACHC pharmacy accreditation
- 3+ Years of experience in practice consulting
- Demonstrated experience in developing customer performance improvement plans
- Knowledge of pharmacy systems, pharmacy and pharmacy workflow
- Able to travel up to 40% of the time
Desired Qualifications
- Specialty Pharmacy experience a plus
- Wholesale Distributor experience a plus
- Community Oncology experience a plus
- Experience in provider consulting a plus
- Knowledge of PBM audit targeting and audit risk mitigation a plus
- Experience with pharmacy claims adjudication, claim rejections and associated resolutions a plus
- Develop a proficiency in orals oncology segment and technology (product, application, platform)
- Technologically Savvy
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