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Years of Experience
Date Last Verified
ProfileContract Representative Senior Responsibilities: Conduct complex contract drafting, review, redlining, administration and document management for all contracts between the business area and its relevant external entities; Review and address language changes and modified text within agreements submitted to Prime. Manage correspondence throughout the contract and negotiation processes and communicate any necessary information to internal stakeholders or department leadership. May be responsible for rate negotiations as assigned and within the department rate structure and target parameters. May facilitate the contract documentation, approval and signature processes and ensure all contractual obligations are in adherence with company policies, regulatory requirements and business strategy; serve as a liaison for regulatory inquiry. Ensure adherence to the records and information management standards. Monitor contracts against business or industry changes to determine necessity of amendments, extensions, renewal agreements and language updates; Review, interpret and establish process enhancements or changes in response to guidance from the Centers for Medicare and Medicaid Services (CMS) and other regulatory or contractual requirements. Develop and maintain template agreements and conduct version control for exhibits, amendments and other necessary documentation. Represent contracting on cross-functional projects or initiatives. Responsible for assessing applicable laws and regulations and providing detail regulatory assessments to identify and manage drive compliance. Other duties as assigned.
Qualification and Experience
Qualifications: Bachelor’s degree in Business, healthcare management or related area of study, or the equivalent combination of education and/or work experience. 3 years contracting experience with emphasis on analyzing, drafting, redlining and negotiating contracts on behalf of a Pharmacy Benefit Management (PBM) organization or another organization within the healthcare industry. Detail oriented and ability to work with a high degree of accuracy. Ability to complete projects independently and within established timeframes. Enhanced organizational skills with the ability to work on mulitple projects simultaneously. Expert verbal and written presentation skills. Ability to problem solve and interpret complex data. Ability to establish rapport and effectively influence at all levels within an organization. Ability to work with confidential data and maintain privacy. Ability to evaluate and interpret policies and procedures. Proficiency within Microsoft Word and Microsoft Excel. Preferred: Paralegal certification. 2 years comprehensive experience working within Medicare/Medicaid (e.g. insurance, government program operations, managed care practices, and/or provider contracting). Experience with analyzing state and federal regulations. Experience using Contract Management software including maintaining and managing databases.