Sr. 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 Sr. Provider Relations Specialist Job Description The Senior 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. This position is responsible for the solicitation, initiation and maintenance of independent pharmacy agreements and contract administration. Responsibilities Research and resolve pharmacy contract related inquires; evaluate network participation and distribute pharmacy contract documents, coordinate timely, accurate and complete submission of contract deliverables, and the electronic and physical tracking, storage and distribution of contract documents 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 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) 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 a Manager in the Network Management department Potential pay for this position ranges from $50,700.00 - $75,500.00 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 and click on the "Benefits at a glance" button for more detail. Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law. 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 an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. 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.

Salary : $50,700 - $75,500