Director, Healthcare Payor Relations And Medical Billing

About the company 

Albertsons Companies is at the forefront of the revolution in retail. With a fixation on raising the bar with innovation and building belonging through our culture, our team is rallying our company around a unique purpose: to create joy around each table and inspire a healthier tomorrow for every community.

Albertsons Companies is one of the largest food and drug retailers in the United States, with over 2,200 stores in 34 states and the District of Columbia. Our well-known banners include Albertsons, Safeway, Vons, Jewel-Osco, Shaw's, Acme, Tom Thumb, Randalls, United Supermarkets, Pavilions, Star Market, Haggen, Carrs, Kings Food Markets, and Balducci's Food Lovers Market. We support our stores with 22 distribution centers and 19 manufacturing plants.

Placing a premium on adaptability, safety and family well-being, our work model, Presence with a Purpose, offers a hybrid work environment between remote work and office time.  A one-size-fits-all approach does not apply to everyone, and teams are empowered to make decisions best for them.

Bring your flavor

Building the future of food and well-being starts with you. Join our team and bring your best self to the table.

What you will be doing

The position is responsible for the direct management and oversight of the contracting, implementation, and operations functions of our pharmacy service programs administered by Health Plans, Prescription Benefit Managers (PBM),  Managed Care Organizations (MCOs) and other private and public payers. The role focuses on building a pipeline of payors that will reimburse pharmacies for value added services including but not limited to immunizations, prescriptive services, test to treat, clinical interventions and other value-added services further expanding the scope of pharmacy practice. The role includes accountabilities for overall managed care plan profitability and the negotiation of terms for participation with third-party payers bridging the gap between Medical Billing and pharmacy reimbursement to grow sales and optimize margin. The position also serves as a liaison between Health Plans, PBM's, Pharmacy Operations, Third Party Accounting, Pharmacy Systems, Credentialing, Clinical Services, Compliance, and Legal.

Main responsibilities

• Provider network development: Individual will be responsible for promoting and selling services under current and future scope of pharmacy practice. Helping to develop the company's strategy for payers including pipeline development, sales cycle, contracting and onboarding of new business focused on optimization of Medical Billing opportunities for services including but not limited to: immunizations (seasonal/non-seasonal); clinical services (MTM, DSM/Diabetes, HEDIS measures, adherence, health screenings; point of care testing, prescriptive services) incremental fulfillment (Specialty meds, mail order, SNF/NH/LTC facilities, hospice); medication administration.
• Implementation and System Readiness: Coordinating between vendors and internal product teams for the successful implementation and scaling of pharmacy services allowing for Medical Billing connectivity between Albertsons pharmacy systems and payor's billing and documentation platforms. Partnering with pharmacy systems and operations to implement programs as part of pharmacy workflow. 
• Contract negotiation: Collaboration with national and regional Health Plans, PBMs, MCOs, and other providers to negotiate terms, conditions, and rate addenda of contracts. This includes reviewing contract proposals, analyzing reimbursement rates, and negotiating payment terms. 
• Contract management: Overseeing the implementation and administration of contracts, ensuring all parties adhere to the agreed-upon terms. This includes monitoring and optimizing contract performance, resolving disputes, and addressing issues or concerns that arise during the contract period. Coordination with the third-party administration team and help desk supporting field level pharmacy teams. Understanding and facilitating credentialing and enrollment requirements for each provider. 
• Contract performance: Develop an annual sales plan and budget, as well as quarterly forecast updates in conjunction with tracking and monitoring of third-party plan financials and performance against forecasts and budgets using third party analytic resources.
• Relationship management: Continually focused on addressing payer needs with appropriate resources and prioritization of value-added services and products, delivering substantial and profitable growth for the company.
• Compliance and regulatory adherence: Ensuring contracts and reimbursement practices comply with applicable laws and regulations which includes staying up to date with changes in pharmacy and healthcare regulation and implementing necessary changes to contracts and reimbursement processes. 
• Growth mindset: Ability to execute in the near term while charting the course for future years. Development and cultivation of business strategy in coordination with senior management to achieve long-term objectives, as well as the development of new products, programs, and services throughout the organization. Working in partnership with Health Plans and PBMs to expand pharmacy scope of practice and broaden overall healthcare with a focus on Food Insecurity, Directed 
  Spend and Social Determinants of Health (SDOH) within designated health platforms.
• Leadership: Provide proactive leadership, motivate co-workers, and function as an effective advocate for change and growth. Promote a can-do, forward-thinking, goal-oriented, entrepreneurial environment that stresses teamwork, management credibility and success. Elevate a high-performance cross functional team through process, discipline, education, and feedback.

The salary range is $131,200 to $183,640 annually. Starting salary will vary based on criteria such as location, experience, and qualifications. There may be flexibility for exceptional candidates. 

Benefits may include, medical, dental, vision, disability and life insurance, sick pay, PTO/Vacation pay/Flexible Time Off, paid holidays (8-9 days annually) bereavement pay and retirement benefits (such as 401(k) eligibility).  Associates in this position are also eligible for a quarterly bonus.

What we are searching for 

• At least 5 years of managed care experience dealing with major Health Plans, PBMs MCOs, Third-Party Administrators (TPA) and other third-party plans or 5 years of PBM or Health Plan management experience preferred.
• At least 5 years of negotiation experience involving multi-million-dollar contracts.
• Understanding of Medical Billing from Health Plan and retail pharmacy reimbursement. Foresight to bridge the gap between medical and pharmacy billing whether it be evaluating and implementing external vendors or working internally with product to design and develop capabilities. 
• Experience with and knowledge of Medicare and Medicaid plan compliance.
• Familiarity with medical plan reimbursement methodologies such as fee-for-service; capitation, value-based payment models, and related billing and data transmission requirements.
• Knowledge and understanding of medical plan quality metrics and performance measures such as HEDIS and Star Ratings.
• Understanding of medical plan credentialing and provider enrollment. Vision to streamline and standardize processes across multiple Health Plans and payors. 
• Strong financial acumen. Understands pricing, budgeting, forecasting and is operationally astute.
• Bachelor's degree in healthcare administration or a related field. Master's degree, RPh, or PharmD preferred, but not required.
• Proficiency in Microsoft Office Applications, i.e., Excel, Word, PowerPoint, and Access.
• Excellent analytical skills.
• Excellent communication and presentation skills.
• Excellent time management, prioritization, and organizational skills
• Must have at least 3 years of supervisory experience, including performance management.

TRAVEL REQUIREMENTS: 10% 

PHYSICAL ENVIRONMENT

• Some travel may be required.
• Most work is performed in a temperature-controlled office environment.
• Incumbent may sit for long periods of time at a desk or computer terminal.
• Incumbent may use calculators, keyboards, telephone, and other office equipment during a normal workday.
• Stooping, bending, twisting, and reaching may be required in the completion of job duties.

The above statements are intended to describe the general nature of the work performed by the employees assigned to this job. All employees must comply with Company policy and applicable laws. The responsibilities, duties, and skills required of personnel so classified may vary within each department and/or location

What is it like at Albertsons? 

Our 290,000 associates have a passion for great service and building lasting relationships with our customers. Through a companywide focus on innovation, we are continually enhancing our digital and product offerings, making it easy for customers to get what they need, wherever they are.