Careers

Careers

PDMI is always looking for talented individuals like you to join our team. Nearly half of our over 125 member staff have IT degrees and PDMI is proud to call Youngstown, Ohio our home. Full-time positions include competitive salaries, full benefits, 401(k), paid vacations and holidays. View all our open opportunities or use the search tool below.

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Pharmacy Network Contract Administrator
Poland, Ohio
Job Title: Pharmacy Network Contract Administrator Department: Pharmacy Network Reports to: Pharmacy Network Manager FLSA Status: Non-Exempt Prepared Date: March 2017 Revised:  August 2019

 

Summary:

This position is responsible for providing support related to the pharmacy network contracting functions of the company in accordance with the policies and practices of PDMI.  The position is responsible for developing and maintaining relationships with pharmacy service providers, including performing and/or assisting with negotiating service contracts, resolving issues and disputes, and otherwise representing PDMI in a professional manner in the pharmacy benefit management industry.

In the performance of their respective duties and responsibilities, all PDMI employees are expected to conform to the following:

  • Perform quality work within deadlines with or without direct supervision.
  • Interact professionally with other employees, customers, and providers.
  • Work effectively as a team contributor on all assignments.
  • Work independently while understanding the necessity for communicating and coordinating work efforts with other employees, teams, and departments.

Essential Duties and Responsibilities include the following.  Other duties may be assigned.

Contract Management (80%):

  • Perform and/or assist with contract and re-contract negotiations with Chain, PSAO, and Independent pharmacy network providers for lines of business, including but not limited to: commercial, government entities, health plans, long term care, hospice, discount card, coupon, and workers’ compensation benefits
  • Develop effective, ongoing relationships with Chain, PSAO, and Independent pharmacy network providers
  • Interpret and administer pharmacy provider contract language to ensure contract compliance
  • Ensure pharmacy provider information is accurate and communicated to all appropriate channels
  • Be the subject matter expert on the standard pharmacy services agreement language including compliance, Medicare Part D, and performance measures
  • Maintain a detailed level of understanding of pharmacy provider services, including but not limited to:vaccinations, specialty, mail order, long term care, home infusion, hospice, workers’ compensation, retail 30, and retail 90
  • Understand the complex relationships between various pharmacy types, their lines of business, and PSAOs and how those affect the demographics of the pharmacy network
  • Research and report pharmacy provider network activity in the marketplace and provide updates to Client Services and upper management.
  • Address internal and external inquiries related to pharmacy provider networks
  • Fully understand the various aspects of a prescription claim and be able to assist in resolving claims issues with pharmacy providers
  • Gain level of understanding related to Pharmacy Network compliance as well as related legislation affecting PBM industry.
  • Credential providers per current PDMI Credentialing minimum requirements for participation
  • Properly store all paperwork related to credentialing and contracting according to standards and naming conventions in SharePoint
  • Maintain professional levels of communication externally with network providers while monitoring and responding to all external requests

Data Analysis (10%):

  • Assist in preparing and distributing performance reports to provider partners as required per pharmacy service agreements to ensure contract compliance
  • Provide support in tracking and maintaining pharmacy network rate information

Corporate Development (10%):

  • Maintain active participation in NCPDP work groups and other organizations to understand changes or updates in prescription claim processing standards
  • Develop a thorough understanding of the network structure of PDMI’s clients
  • Support Client Services in addressing any pharmacy provider network functions related to a client’s potential needs
  • Fully understand the flow of funds in the PBM industry
  • Create and publish policies and procedures regarding pharmacy provider network contracting
  • Attend industry conferences, trade shows, and meetings (e.g., NCPDP) as necessary for continuing education

Supervisory Responsibilities:

This job has no supervisory responsibilities, although some training/coaching will apply to the following:

  • Share knowledge of duties with fellow employees.  Train/mentor fellow employees.

Competencies, Skills and Other Requirements:

  • A well-organized and self-directed individual who is able to work with minimal amount of supervision
  • Excellent time management skills
  • Ability to function effectively and professionally in a fast-paced environment
  • Ability to multi-task, managing multiple projects/priorities daily
  • Excellent research skills, follow-up skills, documentation skills, and issue-resolution skills
  • Strong internal and external presentation and communication skills
  • Ability to exercise considerable judgment, maintain confidentiality, and act in a diplomatic manner
  • Motivated to meet and exceed expectations
  • Ability to communicate effectively with all levels within an organization
  • Ability to self-develop as rules, regulations, and industry standards change regularly
  • Ability to work extended hours, weekend, and holidays as needed pursuant to industry demands
  • Contract, legal, and compliance experience preferred
  • Strong Rx claim acumen and pharmacy dispensing industry understanding preferred
  • Medicare Part D compliance knowledge preferred
  • Some overnight travel may be required

Education and/or Experience:

  • A Bachelor’s degree in a related field (health administration, business, finance) is required; proven industry experience in the same role may be acceptable in lieu of degree
  • A minimum of three years of prior experience in negotiating contracts for reimbursement in a similar function is preferred; Prior experience in negotiating contracts for reimbursement within the industry is highly preferred
  • Excellent Microsoft Office skills, including Excel, Word, Access, PowerPoint, and Outlook

Physical Demands: The physical demands described here are representative of the physical requirements necessary for an employee to successfully perform the essential functions of the job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the described essential functions.

While performing the duties of the job, the employee is regularly required to talk and hear.  The employee is frequently required to sit and use their hands and fingers to handle or feel.  The employee is occasionally required to stand, walk, and reach with hands and arms.  The employee must occasionally lift and/or move up to 50 pounds.  Specific vision abilities required by this job include close vision and distance vision.

Work Environment: The work environment characteristics described here are representative of the environment the employee will encounter while performing the essential functions of the job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the described essential functions.   The noise level in the work environment is usually quiet to moderate.