Our team is seeking a hands-on team member with a passion for delighting customers, both external and internal. Your enthusiasm for your work shines through in all that you do. Your good nature and sense of humor is a plus.
In this role you will collaborate with internal colleagues and external stakeholders to analyze, manage and coordinate all financial and other information with third-party payor/insurance plans to ensure contract performance is optimized. You will coordinate the production and maintenance of payor contracts and related compliance and business/operations functions. You will analyze both existing and new business opportunities.
Using pharmacy revenue management metrics and standard operating procedures, analyze proposed contracts, addendums and product lines for financial impact.
Review, research and respond to payor issues for ambulatory pharmacy service line.
Process improvement and trend analysis, quality assurance and research.
Audit information submitted on the approved forms for document generation and load into Inmar and other management tools and systems.
Maintain payor and contract data in contract tracking systems and databases to ensure data integrity.
Coordinate and manage online payor documentation files including payor contract library.
Responsible for all payor contract related program documentation.
Support audits, compliance projects, process evaluation and improvement initiatives, and routine reporting.
Update Contract Manager and other appropriate colleagues throughout the system of important developments, potential problems, and related information necessary for effective management and optimization of contract performance.
Utilize contract templates and standard processes under the direction of Revenue Management, Contracting, Legal and Compliance departments.
Maintain databases or potential, contracted, denied and other correspondence records for all related contracting opportunities.
Maintain and update payor contact lists.
One year of experience in a pharmacy operation / business environment.
2 years related experience. Preferably with insurance company/payor or health care provider system.
Strong skills in Excel and other Microsoft Suite applications (PowerPoint, Visio, Word).
This position requires remote work. In addition to adhering to all M Health Fairview policies, guidelines, procedures, the M Health Fairview Commitments, and the Code of Conduct, it is the expectation the following requirements of the remote work policy will be met, including but not limited to:
Remote workspace that is clean, safe,andprofessional.
Maintains an internet connection consistent with Fairview standards at remote workspace.
Remain productive and responsive during their scheduled work hours.
Together with the University of Minnesota and University of Minnesota Physicians we have created M Health Fairview. M Health Fairview is the newly expanded collaboration among the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services. The healthcare system combines the best of academic and community medicine — expanding access to world-class, breakthrough care through our 10 hospitals and 60 clinics.Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Fairview is one of the most comprehensive and geographically accessible systems in the state, with 10 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area.Its broad continuum also includes 60 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider network and health insurer PreferredOne. In partnership with the University of Minnesota, ...Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.