Sr. Provider Relations Specialist - Remote

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 Title

Sr. Provider Relations Specialist - RemoteJob Description

The 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.

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.