Senior Director, Payer Programs - Health and Wellness

Position Summary...This role will be responsible for coordinating strategic negotiation planning, including conducting industry and payer research, supporting retail and specialty pharmacy negotiations and new business development. This role will also involve developing and maintaining relationships with key internal and external stakeholders (industry and governmental), negotiating pricing and drafting agreement terms, drafting policies and procedures, conducting root cause analysis, and ensuring compliance with regulatory requirements and industry standards.What you'll do...Manage and oversee aspects of provider or pharmacy benefit manager (PBM) operations, contracting, claims management, enrollment, and/or provider databases.Understand health plan/PBM and provider managed care principles.Negotiate provider agreements (retail pharmacy and/or specialty pharmacy).Possess excellent communication and organization skills.Develop and analyze operational metrics.Additional responsibilities:Directs teams in the coordination of implementation activities for new accounts and/or large-scale upgrades to existing accounts by:Implementing activities (for example, scoping, budgeting, planning, documenting, reporting).Coordinating with the broader Health and Wellness business unit when required.Overseeing a team that provides customer support during the implementation process.Ensuring that all stakeholders are kept informed regarding project status and progress.Ensuring implementation is completed and defined objectives for the implementation are achieved.Capturing best practices from successful implementations and applying them to other accounts, implementations, or contract negotiations.Directs implementation of core payer program processes by:Overseeing negotiations and re-negotiations of contractual programs.Executing additional implementation and post-implementation requirements (for example, ensuring collections, terminations, pricing, and eligibility are set up and handled).Identifying opportunities to streamline or improve the implementation and post-implementation processes.Directs quality assurance processes and workflows by:Creating and maintaining quality assurance processes and procedures.Establishing system checks to ensure accuracy of eligibility and billing systems.Builds, manages, and owns relationships with outside vendors by:Monitoring and tracking vendor reports and reimbursement rates to ensure claims are processed.Identifying opportunities for system modifications.Evaluating new vendors, providing vendor recommendations to management.Oversees risk mitigation for government and commercial payers and ensures compliance with federal and state regulatory requirements and company standards for supporting programs by:Conducting evaluations of current and future contracts and guidelines to assess short and long-term change requirements.Provides overall direction by:Analyzing business objectives and customer needs.Developing, communicating, building support for, and implementing business strategies, plans, and practices.Analyzing costs and forecasts and incorporating them into business plans.Determining and supporting resource requirements.Evaluating operational processes.Measuring outcomes to ensure desired results.Identifying and capitalizing on improvement opportunities.Promoting a customer environment.Demonstrating adaptability and sponsoring continuous learning.Develops and implements strategies to attract and maintain a highly skilled and engaged workforce by:Diagnosing capability gaps.Recruiting, selecting, and developing talent.Supporting mentorship, workforce development, and succession planning.Leveraging the capabilities of new and existing talent.Cultivates an environment where associates respect and adhere to company standards of integrity and ethics by:Integrating these values into all programs and practices.Developing consequences for violations or non-compliance.Supporting the Open Door Policy.Develops and leverages internal and external partnerships and networks to maximize the achievement of business goals by:Sponsoring and leading key community outreach and involvement initiatives.Engaging key stakeholders in the development, execution, and evaluation of appropriate business plans and initiatives.Supporting associate efforts in these areas.Minimum Qualifications:Bachelor’s degree and 6 years’ experience in billing, healthcare, legal, or related area OR 8 years’ experience in billing, healthcare, legal, or related area. 3 years’ supervisory experience.Primary Location:2501 Se J Street Ste B, Bentonville, AR 72712-7761, United States of America

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