Client Careers >> Consultant, Commercial Payer Business Intelligence
Consultant, Commercial Payer Business Intelligence
Summary
Title:Consultant, Commercial Payer Business Intelligence
ID:1045
Client:DK Pierce & Associates
Job Type:Full-time
Location:Zionsville, Indiana
Description
  • Are you looking for a company that values its employees, their input, and creativity?
  • Are you excited by the dynamic biopharmaceutical industry?
  • Do you want an opportunity that allows you to take ownership for your role and make a difference?

If your answer is YES to these questions, then learn more about the Consultant, Commercial Payer Business Intelligence with DK Pierce & Associates.

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, Commercial Payer Business Intelligence. 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.  This role will be heavily focused on the commercial payer environment.

 

Key Responsibilities

Project management

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

Payer intelligence tracking, documentation and communication

  • Track/monitor (on a daily basis) a variety of activities and trends within the commercial payer environment, 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 appropriate proprietary DKP 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 payer business intelligence/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 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 DKP PayerScope Payer Business Intelligence 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.

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.

 

 

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