• 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?

If your answer is YES to these questions, then learn more about the Associate, Payer and Policy Monitoring Services 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 Associate, Payer and Policy Monitoring Services. This role performs daily tracking of select commercial payers including Medicare Advantage (MA), Medicare Prescription Drug Plans (PDP) and managed Medicaid coverage, coding and payment information for a variety of drug products, devices and/or procedures. This role is a critical link to identifying changes or updates for specific data points regarding health insurance issues, trends and changes that impact access to our clients’ biopharmaceutical/medical device products.

Key Responsibilities

Project management

• Design and manage project timeframes, and all related deliverables including interim reports and final presentations.
• Collaborate closely with DKP team (PayerScope and LifeCycle) to understand business objectives for projects.

Payer research, information tracking, documentation and communication

• Research and track (on a daily basis) a variety of activities and trends for select payer types (government payers, commercial payers, MA, and PDP and managed Medicaid) policies, such as general and drug-specific coverage, coding, and payment policies.
• Coordinate research activities and disseminate research findings to DKP PayerScope Monitoring Services Consultants for development of client communications.
• Organize and input payer information related to drug coverage, coding and payment into the proprietary DKP Compass database and into custom reports.
• Collaborate with DKP PayerScope Monitoring Consultants on the design of appropriate formats to capture important informational endpoints.
• Respond to questions for additional content around monitoring findings.

Data quality and report integrity

• Review internal reports to ensure accuracy and validity of presented information, and develop corrective action plans as needed.
• Ensure accurate input of relevant monitoring findings in the proprietary DKP Compass database.
• 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 all DKP staff (specifically Technology, Analytics and PayerScope monitoring team) to develop and evolve client-specific online reporting tools and query systems based on changing client needs for information.
• Submit and act on recommendations for quality improvements for ongoing monitoring tasks and reporting capabilities and deliverables.

Teamwork (SDWT environment)

• Embrace a team culture of trust and collaboration
• Deliver successful outcomes by working cooperatively with other team members
• Accomplish team goals within the agreed upon time frame while meeting or exceeding quality expectations
• Cross train to develop skills necessary to perform other team roles when called upon
• Demonstrate effective communication skills both one on one and in groups
• Effectively participate in cooperative decision making, problem solving, and influencing
• Provide and receive feedback to enhance personal and/or team performance
• Attend and actively participate in all team meetings

Other Functions

• Portray professional appearance and attitude when attending client meetings, agency and healthcare industry meetings
• Communicate potential company service opportunities and quality improvements for this role as it evolves
• Provide motivation, support, and affirmation to entire DKP team
• Complete special projects as assigned and on time

Qualifications

• Associates degree in healthcare or in a related field required; bachelor’s degree preferred.
• Minimum of two years’ demonstrated experience with strong, successful track record in healthcare policy and reimbursement background required.
• Experience in medical or hospital practice, insurance or biopharma industry required.
• Demonstrated 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.
• Proficient computer skills, including a working knowledge of Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Internet browsers and research, and Microsoft Outlook or other e-mail systems required.
• Excellent written/verbal communication skills with the ability to interact with colleagues, clients, and staff at all levels required.