Advisor, Network and Payor Relations (MAC Support)

Job Description

What Network and Payor Relations contributes to Cardinal Health

At Cardinal Health, the marketing organization is the central hub of business driving activity. Marketing takes the lead on all aspects of the marketing mix - product, price, place, people and promotion. Marketing analyzes customer behavior to understand their needs, and motivations, broadly defines and communicates the brand purpose and passionately delivers total solutions for our customers

Network and Payor Relations is responsible for the development and management of business relationships with Pharmacy Benefit Management (PBM) companies and Health Plans. Responsibilities include contracting activities, network and performance participation for Cardinal Health and its Pharmacy Services Administrative Organizations (PSAOs). This involves identifying and evaluating strategic opportunities for all lines of business including Medicare, Medicaid, and various commercial markets.

Key responsibilities include managing the appeal process, analyzing data to identify pricing issues, ensuring regulatory compliance, maintaining communication with stakeholders like pharmacies and PSAO leadership, and improving the MAC appeals process. This role is critical for ensuring fair pricing and adherence to state and federal laws governing PBM practices.

Responsibilities :

• Coordinate and manage the entire MAC appeals process, from initiating an appeal to resolving the dispute
• Analyze data and identify trends related to MAC pricing and provide insights to leadership.
• Monitor and ensure the MAC appeal response adheres to all applicable state and federal laws, statutes, and regulations.
• Serve as a point of contact for pharmacies, providing updates and clarifying information regarding MAC appeals and pricing
• Proactive problem-solving skills to identify and address issues within the MAC appeals process.
• Strong ability to analyze data, identify discrepancies, and draw actionable conclusions regarding MAC pricing.
• Demonstrates basic knowledge of network and payor concepts and applies an understanding of managed care trends to support the review and resolution of appeals and pricing discrepancies.
• Exhibits strong financial acumen and logical decision-making skills in the general business environment. Understands and demonstrates sound thought processes as they relate to pricing and assessing gross margin / profitability.
• Reviews and validates managed care contracts to ensure compliance with organizational policies, regulatory requirements and contractual standards.
• Exhibits an ability to translate market and customer needs into clearly defined goals, objectives, strategies, and tactics to drive sales and profitability for the business. Accountable for gaining and driving cross functional support from all stakeholders.
• Identifies and remains current on payor market and reimbursement trends. Determines product / service lifecycle implications and makes recommendations to maintain market competitiveness to achieve sustainable economic success.
• Understands methods available to execute primary research necessary to drive business decisions. Can identify market opportunities through analysis of network performance and compliance, taking action to implement and manage solutions that meet customer needs.
• Understands the regulatory environment surrounding payor relations, reimbursement, and health policy.
• Works effectively across cross functional groups including but not limited to IT, communications, operations, sales, and finance.
• Applies comprehensive knowledge and a thorough understanding of concepts, principles, and technical capabilities to perform varied tasks and projects.
• May contribute to the development of policies and procedures.
• May act as a mentor to less experienced colleagues.
• Completes work independently; receives general guidance on new projects.

Qualifications

What is expected of you and others at this level

Anticipated pay range : $67,500-$86,670

Bonus eligible : Yes

Benefits : Cardinal Health offers a wide variety of benefits and programs to support health and well-being.

Application window anticipated to close : 12 / 29 / 2025

The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.

Cardinal Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.