Payor Analyst Job Listing at CPS in Dublin, Ohio (Job ID 16758)

Description

Payor Analyst
CPS Solutions, LLC
Home-Based / Remote

As a full time, exempt CPS Solutions, LLC Payor Analyst, you will coordinate and support efforts to improve payor access and evaluate additional opportunities for clients.   You will utilize adjudication denials, analytics, and other contract opportunities provided by leadership to ensure clients achieve maximum value; lead the development and execution of an enhanced process to evaluate pharmacy claims rejections; and provide insights into active and contracted payor agreements for customer sites. This position will utilize CPS Solutions, LLC technology and analytics solutions to conduct analyses and make recommendations for opportunities that will align with site and corporate level initiatives.  Additionally, this position will provide the following centralized/oversight responsibilities: 

Salary range: $70,000-$80,000 based on experience

• Evaluate rejected pharmacy claims that are referred centrally for appeals and or new contract requests; 
• Contract additional payor opportunities resulting from claims rejection data analysis; 
• Produce reports and recommend contract opportunities and potential value related to those contracts to the site and CPS leadership;
• Compile and evaluate quarterly/annual reporting to ensure Performance Guarantees and Payor metrics are being met and maintained at a site-by-site level
• Develop policies, procedures, and training materials at the site level and CPS team members;
• Evaluate and offer guidance on contract rates and the impact to client sites based on independent analysis

Schedule:This position works at least40 hours per week, primarily Monday - Friday and requires travel away from a home location for varying lengths of time up to 50%.

Required Qualifications:

• Bachelor's degree in a healthcare related field or in lieu of degree, high school diploma or equivalent with comparable industry experience
• 3 or more years of experience working in retail or specialty pharmacy to include:
  • Experience with online pharmacy claims processing and associated rejections
    
  • Experience and success communicating with insurance, medical or pharmacy companies and appealing denials to a successful outcome and subsequent paid claim using data, influence, and negotiation skills 
  • Experience working with ambulatory care specialists based in clinics at a large hospital or health system is a plus
  • The ability to work across multiple specialties. 
• Strong interpersonal skills and the ability to work with functionally diverse teams across customers 
• Ability to start from scratch, develop protocols and processes quickly, and execute and iterate quickly in service of our patients and providers
• Energy and willingness to be hands-on and do whatever is required to provide the best care to our patients 
• Ability to communicate effectively at all levels inside and outside the organization
• Proficient with Microsoft Office including Outlook, Teams, Word, Excel and PowerPoint
• Able to travel up to 50% of the time by plane or car 
• Must be able to meet company standards for a MVR 

Benefits:  All employees enjoy a competitive salary, eligibility to participate in the 401(k) savings plan with a match.  Full Time employees are also eligible for a comprehensive benefits package, including Medical, Dental and Vision Insurance, Time Off Plan, Company Paid Short- and Long-Term Disability, Basic and Supplemental Life Insurance, Medical Flex and Dependent Care Accounts and more. 

CPS Solutions, LLC Requirements: All employment offers are contingent upon successfully passing a pre-employment (post offer) background check, drug test and signed onboarding documents. Additionally, you may be required to provide medical records or have additional medical examinations/background checks that are a specific requirement of the location or position in which you are hired.  Due to the healthcare requirements of the location where you will work and the clients we support, this may include a COVID vaccine. This applies to internal transfers and status changes for internal CPS Solutions, LLC team members. CPS Solutions, LLC is also committed to a safe and drug free workplace. The use of marijuana for medical purposes accompanied by a prescription, even if permitted by state law, will not be considered acceptable for purposes of explaining a positive lab test result for marijuana.

About CPS Solutions, LLC:  Founded nearly 50 years ago and employing over 2,500 clinical, regulatory, and operational pharmacy professionals, CPS Solutions, LLC, is one of the nation's largest providers of pharmacy services to more than 800 hospitals and healthcare facilities nationwide. CPS Solutions, LLC helps clients tackle a variety of complex issues, such as operational efficiency, rising drug costs, regulatory & compliance, 340B, and specialty pharmacy strategy. CPS Solutions, LLC helps healthcare leaders drive best in class pharmacy operations through skill, expertise, and proprietary technologies. For more information, visit https://www.CPS.com.

We are an Equal Opportunity Employer and do not discriminate against any qualified employee or applicant for employment because of race, color, sex, age, national origin, ancestry, religious creed, sexual orientation, gender identity and/or expression, status as a veteran, mental or physical disability or any other federal, state or local protected class.

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