Consultant, Payer and Policy Monitoring—DK Pierce & Associates

•  Are you looking for a company that values its employees, their input, and creativity?
• Are you excited by the pharmaceutical and medical device industries?
• Do you want an opportunity that allows you to take ownership for your role and make a difference?

 
DK Pierce & Associates, a certified Women's Business Enterprise with more than 100+ cumulative years in the drug and device industry, is searching for a talented and detail-oriented Consultant, Payer and Policy Monitoring. This role performs daily tracking of payer coverage, coding and payment information for a variety of drug products, diagnostics, and/or procedures. The Consultant is the critical link to identifying changes or updates for specific data points regarding fee-for-service and managed care payer issues (Medicaid, Medicare and commercial payers), and reimbursement trends and changes that impact access to our biopharmaceutical clients’ products.
 
Key Responsibilities
 
Project management

• Design and manage project deadlines and all related deliverables.
• Collaborate closely with DKP PayerScope® Monitoring Services team to communicate specifications for reports and data needs.

 Commercial payer information tracking, documentation and communication

• Track/monitor (on a daily basis) a variety of activities and trends within a specified payer type (Medicare, Medicaid, commercial payers) such as general and drug-specific coverage, coding, and payment policies, key relationships with payer entities such as pharmacy benefit management companies and specialty pharmacies
• Identify key regulations that will affect drug coverage and access for patient care
• Organize and input payer information in the proprietary DKP Compass™ database and custom client deliverables related to drug coverage, coding and payment
• Collaborate on the design of appropriate formats to capture important informational endpoints
• Design client communications on important payer-specific information that may impact the client’s strategic planning and patient access to care with specific treatment options
• Track, develop and foster contact relationships with payer entities and their external contractors for direct communications and primary research
• Serve as a client point of contact to triage key questions on monitoring activities/reporting

Data quality and report integrity

• Review all internal team communication reports and external client-facing reports specific to payer information, to ensure accuracy and validity of presented information, and develop corrective action plans as needed
• Analyze research results and prepare concise summaries and reports for internal and external dissemination
• Ensure input and maintenance of relevant findings in the proprietary DKP Compass™ database and in reports and documents on client portals
• Meet and exceed client expectations for reporting structure, format and information accuracy
• Follow internal DKP processes and procedures related to organization and storing of key reports and information

Quality improvement

• Work with Information Technology and DKP PayerScope® monitoring team to develop and evolve client-specific online reporting tools and query systems based on changing client needs for information.
• Work with Analytics and PayerScope monitoring team to develop and evolve client-specific online reporting tools and query systems based on changing client needs for information
• Establish a highly collaborative working relationship with other Consultants, to consistently share findings and expand knowledge on the entire payer environment, including Medicare, Medicaid, commercial and  Health Insurance Exchange marketplace plans
• Submit and act on recommendations for quality improvements for ongoing daily monitoring tasks and reporting capabilities and deliverables for maximum efficiency

 
Qualifications

• Bachelor’s degree in healthcare or in a related field required; advanced/specialized degree (MPH, MBA, RPh, PharmD, etc.) a plus.
• Minimum of three years’ demonstrated experience with a strong, successful track record in healthcare policy and reimbursement background required.
• Experience in medical or hospital practice, insurance or biopharma industry required.
• Direct experience working with Medicaid fee for service agencies and/or managed Medicaid plans, Medicare Parts B, C and D, or commercial payers preferred.
• Technical knowledge related to drug and healthcare delivery, including coding systems (e.g., CPT HCPCS, ICD-9, ICD-10, NDC), claims payment methodologies (e.g., ASP, AWP), utilization management processes (e.g., formulary tier design, prior authorization criteria) required.
• Experience with navigating and interpreting information stored within payer websites, including as examples: clinical policies, prior authorizations, specialty pharmacy drug lists, Preferred Drug Lists (PDL), fee schedules, open meetings, relevant contacts.
• Highly proficient in MS Office Suite, particularly Excel and PowerPoint, internet, Outlook email, with the ability to learn other applicable software as needed required.
• Strong verbal and written communication skills, and ability to communicate effectively with colleagues, clients, and staff at all levels.
• Ability to work off hours on occasion to meet project completion deadlines

 
Compensation and Benefits
DK Pierce & Associates offers a stellar benefits package that includes health, dental, life, and disability insurance, a competitive paid time off program, and many other unique benefits. The successful candidate will receive a competitive compensation package based on his or her qualifications and experience.