Analyze, Advise, Deliver—Your Consulting Career Starts Here
At Envision, we provide consulting and outsourcing solutions to the life sciences industry, helping manufacturers manage revenue and compliance.
The opportunity
As a Senior Consultant, you will provide strategic guidance and support to healthcare organizations in managing their relationships with insurance providers and optimizing reimbursement for services. You will analyze and negotiate contracts, evaluate payment models, and develop strategies to improve cost-effectiveness and quality of care. Additional responsibilities include regulatory compliance, network development, and financial analysis.
Role responsibilities
- Manage executed managed care contracts from system entry through to rebate validations and payment using multiple systems in a timely and compliant manner.
- Ensure accurate and timely processing of assigned accounts including system entry, rebates, validation, reporting, correspondence, and all other aspects of commercial contract administration.
- Perform detailed analysis and validation of rebate claim data in order to accurately adjudicate the managed care rebates according to the terms specified in the contracts.
- Perform formulary review on a quarterly basis to confirm formulary position of products on contract.
- Set up and maintain contracts pertaining to assigned accounts in rebate adjudication system and ensure that they properly reflect the contract terms and requirements.
- Review key financial, membership and utilization reports to monitor trends and research any significant changes in utilization.
- Collaborate with team members across multiple departments to facilitate the exchange of information, address needs, and clarify contract requirements with internal and external customers.
- Serve as liaison between management and customers in order to resolve any disputed rebate claim data.
Skills & expertise
- Bachelor's degree in Healthcare, Accounting/Finance, Business Administration or Technology related field required.
- Minimum 5 years of managed care consulting, healthcare finance, or payer contracting required.
- Minimum 2 years of managed care contract negotiating with improved financial performance required.
Salary range
$93,800 - $122,000
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