Specialist Payer Relations

Versiti, Inc.•Milwaukee, WI

9d•Hybrid

About The Position

The Payer Relations Specialist serves as the subject matter expert for payer engagement and managed care strategy. This role is responsible for developing and maintaining relationships with commercial health plans, pharmacy benefit managers (PBMs), government payers, and employer stakeholders to gain network participation and optimize reimbursement for Versiti's Comprehensive Center for Bleeding Disorders (CCBD) Hemophilia Treatment Center (HTC) and 340B Specialty Pharmacy. The Payer Relations Specialist collaborates with HTCs, institutional contracting teams, advocacy organizations, and internal departments to advance payer access, support specialty therapy distribution strategies, and promote CCBD as a Center of Excellence for bleeding disorder care.

Requirements

Bachelor's Degree in Business Administration, Healthcare Administration, or related field required
At least 5+ years of progressive experience in healthcare payer relations, managed care, or provider network contracting required
Knowledge of managed care, PBMs, and payer contracting processes, including specialty therapy reimbursement and network participation. required
Understanding of medical and pharmacy benefit structures, including buy-and-bill and specialty pharmacy distribution models. required
Ability to develop and maintain strategic relationships with payers, PBMs, advocacy organizations, and institutional partners. required
Ability to manage multiple projects, prioritize tasks, and travel nationally as required. required
Microsoft Suite (Word, Excel, PowerPoint, Outlook) required
Personal Computer (desk top, lap top, tablet) required
General office equipment (computer, printer, fax, copy machine) required

Nice To Haves

Less than 1 year experience with Hemophilia Treatment Centers (HTCs), specialty pharmacies, or rare disease provider networks preferred
Strong analytical, negotiation, and problem-solving skills for evaluating contracts, reimbursement trends, and policy changes. preferred
Excellent verbal and written communication skills preferred
Ability to exercise independent judgment and discretion in payer strategy and contracting initiatives. preferred
Knowledge of regulatory compliance and specialty pharmacy accreditation standards. preferred

Responsibilities

Develop and maintain relationships with commercial insurers, PBMs, government payers, and employer groups; negotiate participation agreements and ensure network access.
Monitor coverage policies, reimbursement, and market trends.
Work with the CCBD and Pharmacy teams to support payer contracting, reimbursement strategies, and network participation.
Provide guidance and education to strengthen payer engagement.
Collaborate on wholesale drug distribution agreements and specialty therapy access strategies.
Participate in the development and implementation of payer relations strategies.
Engage with patient advocacy organizations and employer groups to promote CCBD as a Center of Excellence.
Ensure all payer contracting, PBM participation, and specialty therapy distribution activities comply with federal, state, and payer regulations.
Support CCBD/Pharmacy in meeting accreditation requirements and maintain documentation for audits or regulatory review.
Attend industry conferences, payer meetings, and trade associations.
Track policy changes and share insights to strengthen effectiveness with payers.
Maintain documentation, review contracting data, support internal reporting, and track contract performance metrics.
Performs other duties as required or assigned which are reasonably within the scope of the duties in this job classification.
Understands and performs in accordance with all applicable regulatory and compliance requirements.
Complies with all standard operating policies and procedures.