Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.Job Posting TitleSr. Provider Relations Specialist - RemoteJob DescriptionThe Sr. Provider Relations Specialist is responsible for managing contracting efforts for low to mid complexity pharmacies. This position is responsible for drafting and managing all pharmacy communications to network pharmacies and issue resolution for escalated contract, claim processing and pharmacy payment inquiries.Responsibilities
Conduct root cause analysis including but not limited to, investigating, monitoring, resolving and reporting for pharmacy contract issues, grievances initiated by Government Programs Research Team (GPRT), and resolving CMS Prescription Drug Events (PDE) rejections within the required turnaround times
Serve as a primary point of contact for electronic transaction file set-up and maintenance
Serve as liaison between key pharmacy chains, Network Management, Client Engagement, Finance, Benefit Operations to resolve escalated issues and complete root cause analysis in a timely manner
Draft and manage communication efforts on behalf of Network Management, Client Engagement, Compliance, and Government Programs to participating pharmacies
Identify trends in escalated pharmacy issues and develop strategies to enhance processes and reduce the number of escalated pharmacy issues and report to Network Management leadership and other stakeholders
Facilitate correspondence throughout the contract and negotiation processes and communicate any necessary information to internal stakeholders or department leadership
Triage all applicable issues to Prime network vendors and monitor responses for timely completion and escalation
Other duties as assigned
Minimum Qualifications
Bachelor’s degree in Business or related area of study, or equivalent combination of education and/or relevant work experience
2 years of work experience in a call center, customer service, operations, retail pharmacy, pharmacy technician, Pharmacy Benefit Management (PBM), or other relevant experience in a related industry
Must be eligible to work in the United States without need for work visa or residency sponsorship
Additional Qualifications
Detail oriented and ability to work with a high degree of accuracy
Demonstrated ability to complete projects independently and within established timeframes
Enhanced organizational skills with the ability to work on multiple projects simultaneously
Expert verbal and written presentation skills
Demonstrated ability to problem solve and interpret complex data and situations
Ability to establish rapport and effectively influence at others within an organization
Enhanced ability to work with confidential data and maintain privacy
Advanced ability to evaluate and interpret policies and procedures
Ability to work in fast-paced, collaborative team environment
Proficiency within Microsoft Word and Microsoft Excel
Preferred Qualifications
Experience working with RxClaim system or other claims processing experience]
Pharmacy Technician certification (CPhT) or equivalent pharmacy experience
Experience using Contract Management software including maintaining and managing databases
Minimum Physical Job Requirements
Ability to work a flexible schedule including shifts outside of Prime’s core business hours of 8:00 a.m. to 4:30 p.m.
Constantly required to sit, use hands to handle or feel, talk and hear
Frequently required to reach with hands and arms
Occasionally required to stand, walk and stoop, kneel, and crouch
Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
Reporting Structure
Reports to Manager, Provider Relations
Potential pay for this position ranges from $51,700.00 - $77,100.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/careers/benefits/) and click on the "Benefits at a glance" button for more detail.Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law.We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.Prime Therapeutics LLC is a Tobacco-Free Workplace employer.Positions will be posted for a minimum of five consecutive workdays.Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law.We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.Prime Therapeutics LLC is a Tobacco-Free Workplace employer.If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.
Full-time