Contract Compliance Director

AlignRx is a Public Benefit LLC (PBLLC)—a for-profit limited liability company that is intended to produce a public benefit and to operate in a sustainable manner. We are the only PSAO to establish itself as this type of legal entity, as we are deeply committed to promoting the interests of community pharmacies. You can count on us to be transparent, accountable, and passionate.

As an independently owned PSAO, we want community pharmacy owners to have maximum flexibility in their buy-side choices so they can maintain control over their business. AlignRx does not require pharmacy owners to purchase from a specific wholesaler or buying group. This benefit is just one more reason that community pharmacies experience peace of mind knowing our interests are in sync with theirs.

Our mission is to support community pharmacy by offering innovative products and services that are best in class and designed to promote the pharmacies we serve as essential healthcare providers resulting in improved patient care and outcomes.

Job Summary

This position will serve as the direct manager over the PBM Account Executives—those being the primary contacts with third party payors.

Responsibilities include serving as an escalation path for the PBM Account Executives, independently monitoring payor contract compliance, reporting issues to senior management, redlining contracts, running financial models, and consulting with pharmacy owners. The Contract Compliance Director schedules and leads recurring meetings with PBM counterparts to ensure full contract compliance.

The Contract Compliance Director also has a supporting role in developing contract negotiation strategies, as determined by the Payor Contracting department head.

The Contract Compliance Director supervises and coaches direct reports on the performance of their duties, completes performance reviews, and provides feedback to direct reports.

This position is also responsible for internal and external company resources. Those resources being the Medicare Part D rate guide, commercial rate guide, Medicare Part D landscape, and maintaining the BIN/PCN application.

Essential Job Functions

Management

• Serve in leadership role to PBM Account Executives, ensuring defined goals and objectives are met.
• Supervise PBM Account Executives in managing projects, keeping track of contract issues, and ensuring issues are fully resolved in a timely manner.
• Oversee the onboarding and ongoing training process for PBM Account Executives.
• Define and implement efficient department workflow and draft Policies and Procedures.
• Prepare monthly management reports.
• Review daily reports of issues escalated by customer service to determine appropriate follow-up and issue resolution.
• Conduct performance evaluations in accordance with company policy.

Payor Contract Analysis

• Investigate PBM legal contract compliance issues and independently seek resolution with the PBMs.
• Perform claims analyses to validate claims are being paid in compliance with contract rates and state law.
• Provide internal assistance to the department in assisting contract negotiations including providing insight when requested on redlining new contracts, developing negotiation strategies, running and diagnosing financial models of contract rate proposals.
• Assess the accuracy of claims reports and be able to quickly identify when results appear to be skewed or incorrect. Using the calculations, be able to filter out inapplicable claims and correct data anomalies to ensure accurate contract analysis.
• Know the key terms and nuances of the payor contracts (e.g., reimbursement structure WAC/AWP/NADAC, rates, over/underpayment remedies, and other rights and duties of the parties).

Direct Contract Consulting

• Redline and advise member pharmacies on independent contract terms and conditions.
• Maintain executed direct contract files and related databases.
• Ensure timely turnaround time for incoming direct contract requests.

Clerical

• Have an in depth understanding of the contract structure and mapping of the contract library.
• Maintain the internal BIN/PCN application that matches incoming claim data to the corresponding networks.
• Prepare and submit the Commercial and Medicare Rate Guides at the expected frequency.

Internal Relations

• Serve as a resource to Provider Relations staff to address PBM contract questions.
• Serve as a resource for sales and marketing team regarding contract status questions from prospective member pharmacies.
• Determine when a contracting issue requires communication to the pharmacies. Draft network communications, inform relevant departments of the content, submit the communication request to the Marketing department.
• Understand the responsibilities of the PBM Account Executives and the division of labor within the company more generally to be able to determine what issues should not be resolved by Payor Contracting and reroute them accordingly.
• As requested, present departmental work at board subcommittee meetings, webinars with the pharmacies, internal cross-departmental trainings, new hire orientations, etc.

PBM Relations

• Schedule regularly scheduled meetings with payors and lead those conversations efficiently by preparing an agenda to ensure all outstanding issues are fully resolved.
• As requested, attend industry meetings and represent AlignRx to third parties, including the annual NCPDP conference.
• Independently track complex PBM issues to ensure full resolution.
• Managing the Payor Contracting inbox, forwarding emails to the relevant parties.
• Develop processes to generate monthly reports assessing the contract compliance (specifically reimbursement) of PBMs. Maintain these processes in Policy and Procedure format.
• Remain current on relevant state, federal, and administrative law that relate to pharmacy and PBM regulations.
• Remain current on pharmacy industry trends and aware of AlignRx pharmacy member business needs and concerns.
• Track industry trends and plan movement among the PBMs.

Additional Responsibilities

• Perform other duties and projects as required by management.

Minimum Qualifications for Consideration

• Bachelor's degree in a business-related field.
• Five to seven years proven track record in contract management.

Knowledge, Skills, and Abilities

Skills other than formal education or training required to do the job. Samples include:

• Excellent verbal and written communication skills.
• Good interpersonal skills: able to work well with a wide range of people.
• Keen attention to detail.
• Strong organizational and time management skills.
• Demonstrate dependability through good attendance and adherence to timelines and schedules.
• Exceptional follow through on projects and deliverables.
• Good analytical skills, data interpretation.
• Complex problem-solving skills.
• Demonstrate resourcefulness and ability to take initiative in development and completion of projects.
• Strong sense of customer service.
• Demonstrate basic computer knowledge through effective use of a personal computer including Microsoft Office applications. Computer skills to include file management skills, Internet, Microsoft Windows, database, word processing (Word), spreadsheets (Excel), presentation software (PowerPoint), graphics.
• Understanding how and why claims process: i.e., calculation of co-payments, pricing hierarchies, etc. Including "if-then" statements.
• Knowledge of and experience in the industry with regard to terminology and functions for retail/other pharmacy.
• Basic drug knowledge and understanding of Therapeutic Categories (TC), Multi-Source Indicators (MSI), Generic Product Identifier (GPI), Generic Code Number (GCN) etc. Drug/claim statuses: Paid vs. Captured; PDL/NPDL; "F" – Formulary (paid) vs. "G" – Non-formulary paid, etc.

Physical requirements/Working Conditions

This work is sedentary and requires the following physical activities:

• Sitting for long periods of time; occasional bending, squatting, kneeling, stooping; good finger dexterity and feeling; frequent repetitive motions; talking, hearing, and visual acuity.
• Frequent lifting (up to 20 pounds of paper supplies or minor office equipment).
• Driving to meetings and other sites as needed.
• Work from home.

Direct reports

Yes.

Benefits

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

NOTE: The above statements are intended to describe the general nature and level of work performed by an employee in this position. These statements are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of employees in this position.

AlignRx is an equal opportunity employer and is committed to providing a workplace free from harassment and discrimination. We celebrate unique differences of our employees, knowing diversity drives innovation, and the success of our business. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, gender identity or expression, age, marital status, veteran status, disability status, pregnancy, parental status, genetic information, political affiliation, or any other status protected by applicable laws or regulations.

Job Type: Full-time

Pay: $97, $129,600.00 per year

Education:

• Bachelor's (Required)

Experience:

• Contract management: 5 years (Required)

Work Location: Remote