Provider Relations Specialist

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

Provider Relations Specialist

Job Description

The Provider Relations Specialist is responsible for providing ongoing support to Prime's participating pharmacies, clients, and internal and external stakeholders. This position is responsible for conducting the necessary claims research for escalated pharmacy and client inquiries, offering issue resolution for claims processing and pharmacy payment in order to resolve inquiries.

Responsibilities

• Research and resolve pharmacy contract related inquires
• Evaluate pharmacy claims payment and billing inquires, EFT set-up and maintenance, and reconciliation vendor set-up and maintenance
• Monitor and evaluate all pharmacy inquiries received through the Provider Relations email box and phone lines and collaborate with internal stakeholders
• Prepare pharmacy outreach reporting to internal and external stakeholders
• Research and escalate drug pricing analysis complaints
• Maintain Chain and Pharmacy Services Administration Organization (PSAO) network updates
• Conduct root cause analysis, including but not limited to, investigating, monitoring, resolving and reporting for grievances initiated by Government Programs Research Team (GPRT)
• Identify and participate in implementing department level process improvements
• Manage and draft communication reports on behalf of Network Management, Client Engagement, Compliance, and Government Programs to participating pharmacies.
• Process pharmacy remittance requests
• Other duties as assigned
  
  

Education & Experience

• 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)
• Must be eligible to work in the United States without need for work visa or residency sponsorship
  
  

Must be eligible to work in the United States without the 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
  
  

Physical Demands

• 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
  
  

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Potential pay for this position ranges from $59,000.00 - $94,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page 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, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local 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.