Ambulatory Pharmacy Contracting Specialist
Job ID: R0039401 | Health Services Administrative | Full Time | Charlottesville, VA
The Ambulatory Pharmacy Contracting Specialist will perform a variety of administrative functions for UVA Health's owned pharmacies including the monitoring and finalizing of pharmacy agreements as well as ongoing review and maintenance of agreements. The individual will work collaboratively with the Managed Care Department to provide oversight and expertise for retail and specialty Pharmacy contracting. The Ambulatory Pharmacy Contracting Specialist will provide problem solving, auditing, reporting, and process recommendations for optimal departmental outcomes. Individual is responsible for providing support in managing payor relations, contract implementation, analysis of contracts, facilitating internal company communication regarding payor clients, negotiation of contracts, and managing payor contract requirements, in order to maintain compliance and contract obligations.

The individual will provide oversight and management of A/R reconciliation and timely issue resolution. This includes alerting management of trends with incorrect reimbursements, unfavorable contract terms, and contract provisions affecting pharmacy reimbursement. This position will monitor and report on contract performance metrics including but not limited to volumes, performance, fees, and value-based outcomes. Additionally, this position will participate in routine pharmacy compliance audits and internal monitoring focusing on compliance and proper documentation.
  • Timely and accurately complete new and renewing contact documents.
  • Serve as the primary contact for assigned contracts, interacting with Managed Care department and payors to facilitate problem resolution
  • Manage, review, and follow up of pending contracts and provide support for timely completion, update contract files upon contract execution
  • Coordinate with management and other stakeholders on all new payor contracts for possible negotiations and rate validation
  • Manage and evaluate A/R and address issues to resolution. Serve as point of contact for A/R management system.
  • Prepare reports on contract performance metrics including but not limited to volumes, performance, fees, and value-based outcomes.
  • Able to work independently with minimal supervision.
  • Conduct ongoing follow-up and status updates of pending items
  • Communicate effectively with external and internal departments.
  • Ensure that contractual documents are recorded and saved according to departmental policies. Ensure ongoing maintenance of departmental database and demographic information for all pharmacies and their contracts. Maintain paper and electronic copies of pharmacy agreements and supporting documents.
  • Establish and maintain strong work relationships with both external and interdepartmental staff.
  • Maintain regular attendance in accordance with established policies.
  • Participate and perform other related duties as assigned by Leadership.
Position Compensation Range: $61,443.20 - $98,300.80 Annual


MINIMUM REQUIREMENTS

  • Education: Bachelor's degree in business, finance, accounting, or healthcare related field. Juris Doctor or Master's degree in business, finance, accounting, or healthcare related field preferred.
  • Experience: 3 years of experience with managed care and/or pharmacy contracting, or equivalent combination of education and experience. Five years of experience pharmacy contracting preferred.
  • Licensure: None

 

PHYSICAL DEMANDS

Job requires standing for prolonged periods, frequently bending/stooping, reaching (overhead, extensive, repetitive) and repetitive motion: computer keyboard. Proficient communicative, auditory, and visual skills. Attention to detail and ability to write legibly. Ability to lift/push/pull < 20lbs. May be exposed to chemicals.


COVID Vaccination Requirement and Guidelines

 

Please visit the UVA COVID-19 Job Requirements and Guidelines webpage prior to applying for current information regarding vaccination requirements and guidelines for employment at UVA.

 

 

 


Medical Center (Charlottesville, VA)
Charlottesville, VA 22903

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