Insulet Corporation

Director, Payor Contracts

Job Locations US-MA-Billerica | US-MA-Billerica
Posted Date 1 month ago(1/22/2018 5:50 AM)
Category
Managed Care / Market Access

Position Summary

The Director, Payor Contracts Management is responsible for facilitating and managing the entire contract life cycle of Managed Care, Distribution Channel, Pharmacy Channel, and Government contracts.   This position works closely with Field Managed Care and the Distribution Channel team in developing and maintaining agreements that provide medical providers and patients with access to our services while aligning with Insulet’s goals and objectives. 

Responsibilities

  • Ensure Insulet Market Access Contracts team is appropriately staffed to ensure timely processing of contract and credentialing documents between Insulet and payors, PBMs, distributors, wholesalers, pharmacies, etc.
  • Develop and maintain systems/processes necessary for timely and accurate development, assessment and administration of contracts, proposals and credentialing documents.
  • Develop contracts/amendments/notifications for Managed Care customers and collaborate with Field Managed Care team in negotiations with payers, distributors, etc.
  • Facilitate contracts through the contract process including review of documents, obtaining all information necessary to successfully implement the contract, obtaining approvals (including development of business cases for proposed terms), communicating appropriate information to the appropriate parties, and updating all relevant systems.
  • Ensure all contractual obligations of all parties are met on a timing basis including data exchange, development of quarterly business reviews, performance milestones or guarantees, rebates, re-credentialing.
  • Ensure Insulet is operating in compliance within contractual obligations entered into with payors, PBMs, distributors, wholesalers, pharmacies, etc.
  • Maintain payer information and contract terms in all systems (includes coverage policy changes, criteria validation processes, member lives, revenue status information).
  • Facilitate conversations with appropriate departments (e.g. billing and reimbursement teams, finance, intake, sales) early in the contracting process to provide updates, discuss potential operational issues, and develop and follow up on plans to address such issues.
  • Involved in the development of action plans for payers that are non-compliant with payment or other contractual obligations, including analyses of potential impact to revenue.
  • Assist in managing payer specific and national price changes (includes monitoring the timing, calculations, communications with payers and internal departments).
  • Assist in the development and ongoing maintenance of boilerplates, including facilitating review with appropriate internal parties and legal.
  • Coordinate review of any ‘non-standard’ contract obligations with appropriate parties.
  • Assist with the rollout and tracking of mass communications and/or contracts (e.g. new product, price increase, process change).
  • Ensure accurate and timely processing of credentialing, accreditation needs in order for Insulet to be a par provider in our payor networks. Ensure these are also maintained and kept current.
  • Gather and maintain corporate business information from appropriate departments required for provider credentialing with public and private payers and hospitals.
  • Synthesize lessons learned and update contracts, processes, systems and/or tools.
  • Performs other duties as required.

Education and Experience

  • Bachelor’s degree; Master’s degree preferred and/or equivalent combination of education and experience.
  • 7-10 years contracting experience within the healthcare industry; previous people leadership experience required.
  • Knowledge of and/or experience with private Managed Care payers, Distribution Channel groups, and reimbursement process.
  • Understanding of market-related issues, contract development, negotiation, and pull through as well as the legal and regulatory implications associated with Private and Government payer contracting.

 Skills/Competencies:            

  • Strong communicator with the ability to maintain open communication with employees, managers and customers as needed
  • Effective communication skills, both written and oral
  • Ability to influence without authority
  • Strong leadership skills; Ability to lead and work as part of a team
  • Able to integrate and apply feedback in a professional manner
  • Able to prioritize and drive to results with a high emphasis on quality
  • Capable of identifying and implementing enhancement opportunities
  • Ability to coordinate and lead cross-functional teams
  • Strong attention to detail and organizational skills
  • Strong analytical skills and familiarity with Excel and Access (or similar database)
  • Ability to present recommendations supported by analytical evaluations
  • Capable of prioritizing and managing several, complex projects at once
  • Knowledge of and/or experience with government Managed Care payers and reimbursement process is a plus
  • Strong computer skills (MS Office, Outlook, Word, Excel)
  • Knowledge of billing and coding is a plus
  • Comfortable with web technology / document management systems / account management systems
  • Travel as required to support business needs

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