PBM Contract Representative Sr - LA Medicaid

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Job Posting Title

PBM Contract Representative Sr - LA Medicaid

Job Description

The Senior Contract Representative is responsible for contract administration and ensuring process adherence in support of Prime’s contracting efforts with Louisiana Medicaid PBM business. This position is responsible for supporting the solicitation, initiation and maintenance of Prime’s agreements with various business entities within their designated business area. If supporting Pharm Trade Relations, this position may also have responsibility for developing, maintaining and ensuring the quality of Prime’s agreements and drafts contract language, conducting negotiations, implementing executed agreements and establishing the appropriate documentation to support the business strategies of their department.

Responsibilities

• Conduct moderate to complex contract drafting, review, redlining, administration and document management for contracts between the business area and its relevant external entities
• Manage correspondence throughout the contract and negotiation processes and communicate any necessary information to internal stakeholders or department leadership
• May be responsible for rate negotiations as assigned and within the department rate structure and target parameters
• Facilitate the contract documentation, approval and signature processes and ensure all contractual obligations are in adherence with company policies, regulatory requirements and business strategy; may serve as a liaison for regulatory inquiry
• Support all contracting and re-contracting initiatives through the coordination of electronic and physical tracking, storage and distribution of contract documents, and adherence to the records and information management standards, ensuring accurate and timely execution
• Develop and maintain Standard Operating Procedures, templates and Desktop Procedures for assigned tasks and identify opportunities for improvement within contract document development, implementation, and maintenance processes
• Represent department on interdepartmental and cross functional projects or initiatives
• May be responsible for monitoring contracts against business or industry changes to determine necessity of amendments, extensions, renewal agreements and language updates; review, interpret and establish process enhancements or changes in response to guidance from the Centers for Medicare and Medicaid Services (CMS) and other regulatory or contractual requirements
• May serve as a team leader and mentor to junior level team members and serve as a point of escalation support to internal and external business partners
• May lead department contracting strategy for junior level team members and collaborate with department leadership team on re-contracting strategy
• Other duties as assigned

Minimum Qualifications

• Bachelor’s degree in Business, healthcare management or related area of study, or the equivalent combination of education and/or work experience; HS diploma or GED is required
• 2 years of contracting experience with emphasis on analyzing, drafting, redlining and negotiating contracts on behalf of a Pharmacy Benefit Management (PBM) organization or another organization within the healthcare industry
• Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

• Detail oriented and ability to work with a high degree of accuracy
• Demonstrated ability to complete projects independently and within established timeframes 
• Enhanced organizational skills with the ability to work on multiple projects simultaneously
• Expert verbal and written presentation skills
• Demonstrated ability to problem solve and interpret complex data
• Ability to establish rapport and effectively influence at all levels within an organization
• Ability to work with confidential data and maintain privacy
• Ability to evaluate and interpret policies and procedures
• Proficiency within Microsoft Word and Microsoft Excel

Preferred Qualifications

• 2 years of comprehensive experience working with Rebate contracts, or within Medicare/Medicaid (e.g. insurance, government program operations, managed care practices, and/or provider contracting)
• Paralegal certification
• Experience with analyzing state and federal regulations
• Experience using Contract Management software including maintaining and managing databases

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