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Tomorrow's health is... Defining a new possible.

Sr. Payer Specialist

Irving, Texas Job ID JR0113751 Category Client Relationship Post Date Jun. 27, 2024
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McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve – we care.

What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow’s health today, we want to hear from you.

The Medically Integrated Dispensing (MID) Sr. Payer Specialist help practices optimize their medically integrated pharmacies and dispensaries through accreditation, PBM contracting, PBM audit risk mitigation, and continuous quality improvement initiatives. Responsibilities include working with practices to gain and maintain accreditation, develop and maintain continuous quality improvement programs.  Acts as a consulting advisor to practices to optimize patient access, achieve patient advocacy, build plan sponsor partnerships, and develop contracting strategies. This position works closely with the McKesson Account Executives, MID account management and optimization teams to ensure high-quality and consistent service to practices. 

The position requires subject matter expertise in pharmacy contracting, Pharmacy Service Administration Organizations (PSAOs), pharmacy credentialing and accreditation. Keeps up-to-date knowledge of the industry, competition, and enhances awareness within retain and specialty pharmacy business models and the medically integrated dispensing segment. This position requires excellent communication, customer service and follow-up skills.

Key Responsibilities

Pharmacy & Dispensary Accreditation and continuous improvement

  • Ability to guide practices through URAC, ACHC, and other accreditations

  • Assists practices with integration and maintenance of accreditation requirements

  • Assists practices with operation of continuous improvement programs

Contracting Support

  • Assists practices with development of payer contracting strategies to optimize network access and reimbursement

  • Guides practices through contract negotiations

Patient Access Strategies

  • Advises practices on how to build patient advocacy

  • Helps practices build plan sponsor engagement strategies

  • Assists practices with building long-range contracting strategies

Minimum Requirements

6+ years pharmacy contracting, pharmacy quality improvement, and/or pharmacy regulatory and payer compliance.

Critical Skills

  • Strong experience developing internal and external relationships/partnerships

  • Demonstrated experience in developing performance improvement plans

  • Knowledge of pharmacy, pharmacy systems, and pharmacy workflow

  • Experience with pharmacy claims adjudication, claim rejections and associated resolutions

  • Effectively manage customer expectations in terms of service and issue resolution

  • Strong Microsoft Office skills

Additional Skills

  • Experience with URAC or ACHC pharmacy accreditation

  • Experience in practice consulting

  • Specialty Pharmacy 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

  • Develop a proficiency in oral oncology segment and technology (product, application, platform)

Education

  • 4-year Undergraduate College Degree or equivalent experience

Working Conditions

  • General office environment

  • Work from home

  • 40% Travel

Physical Requirements

  • General office demands

We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please click here.

Our Base Pay Range for this position

$102,700 - $171,100

McKesson is an Equal Opportunity Employer

McKesson provides equal employment opportunities to applicants and employees and is committed to a diverse and inclusive environment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age or genetic information. For additional information on McKesson’s full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page.

Join us at McKesson!

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