McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve - we care.
What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow's health today, we want to hear from you.
Position Description
McKesson is seeking a Contract Administrator & Auditor. Reporting to the Manager, Contract Compliance, the Contract Administrator & Auditor is an integral role accountable for key duties and responsibilities related to payer contract compliance, including audits, credentialing, recredentialing, contract documentation and reimbursement adherence. This position is a key liaison between the Contracting team and Compliance, Quality and Operations teams.
Key Responsibilities
Credentialing & Plan Enrollment
Responsible for adhering to an efficient and effective process that guarantees continuous enrollment in Medicaid programs and maintains ongoing credentialing status with commercial and government payers for all pharmacy locations.
Archives all sentinel contract dates and key terms in client relationship management platform and provides monthly status reports as needed to ensure awareness and compliance with credentialing and enrollment deadlines.
Supports Manager, Contract Compliance in all activity associated with corporate updates including officer and staffing changes, site licensing and credentialing for all pharmacy locations.
Acquires and maintains comprehensive and confidential library of corporate documentation including ownership, board and director documentation, delegation of signatory authority, licensing, credentialing files, third party audit results, maintain disclosure file of disciplinary actions by commercial and government payers that impact licensing, status, enrollment or standing.
Ongoing research and documentation of external websites required to comply with Medicare, NCPDP, PECOS, NPI registration and state pharmacy boards as needed.
Establish working relationships and collaborate with external organizations as it pertains to payer credentialing and network status.
Identify and recommend credentialing process and workflow improvements.
Processes administrative tasks as needed and requested by management.
Payer Audit & Quality/Process Improvement
Performs intake, documentation and coordinated response for all patient or drug-specific audits.
Prepares detailed summary and analysis for Quality Assurance teams.
Tracks and trends payer audit experience to drive future contracting strategies as needed.
Performs root cause analysis and initiates remediation.
Evaluate transactions for business feasibility/reimbursement, research, and resolve.
Develops and maintains professional working relationships with clients and within organization.
Assist with development of SOPs and/or other compliance documents as needed.
Thinks creatively and embraces change for the improvement of the company.
Conduct ongoing follow-up and status updates of pending tasks.
Perform related duties as required.
Minimum Requirement
Degree or equivalent and typically requires 4+ years of relevant experience.
Education
Degree or related, equivalent experience.
Critical Skills
Minimum four (4) years' experience in healthcare working in operational or compliance roles.
Knowledge of the insurance or healthcare market; reimbursement and pricing models, experience, and knowledge of compliance activity in heavily regulated industry.
Demonstrate excellent verbal and written communication skills and have the ability to communicate tactfully with department heads, manager, coworkers, and clients to resolve problems and negotiate resolutions.
Attention to detail and proven organizational skills.
Demonstrate analytical skills and the ability to identify trends in large amounts of data, as well as the ability to communicate insights effectively.
Additional Skills
Ability to prioritize and meet deadlines.
Self-motivator with ability to apply knowledge to new situations.
Collaborative, customer focused, and able to create visible value to client and within the organization.
Detailed understanding and experience with process documentation and improvement.
Ability to learn and absorb new information, processes, or tools.
Ability to cross-train others on key tasks and responsibilities.
Proficiency with Microsoft Office Suite.
Competence with Adobe Pro.
Working Conditions
Able to travel overnight domestically 5% of the time.
Hybrid work environment - Ideally located in North Carolina (Cary/Raleigh) or a state in the East/South Region.
Must be authorized to work in the US unrestricted - This position is not eligible for sponsorship.
We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. The pay range shown below is aligned with McKesson's pay philosophy, and pay will always be compliant with any applicable regulations. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please click here.
Our Base Pay Range for this position
$69,800 - $116,300
McKesson is an Equal Opportunity Employer
McKesson provides equal employment opportunities to applicants and employees and is committed to a diverse and inclusive environment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age or genetic information. For additional information on McKesson's full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page.
