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 – Remote

Job 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.

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 todays 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 peoples 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.