Provider Relations Analyst (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

Provider Relations Analyst (Remote)Job Description

The Provider Relations Analyst is responsible for managing contracting efforts for Specialty pharmacies. This position is responsible for drafting and managing all pharmacy communications to network pharmacies and issue resolution for escalated contract, claims processing and pharmacy payment inquiries.

Responsibilities

• Research and resolve Specialty pharmacy contract related inquires; evaluate Specialty 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
• Conduct root cause analysis, including but not limited to, investigating, monitoring, resolving and reporting for pharmacy contract and pricing analysis complaints issues
• Evaluate pharmacy inquiries to include but not limited to: complaints, issues and/or grievances and collaborate with internal stakeholders, such as Network Management, Client Engagement, and Benefit Operation
• Resolve pharmacy related CMS Prescription Drug Events (PDE) rejections within the required turnaround times
• Process electronic transaction file set-up and maintenance
• Manage and draft communication efforts on behalf of Network Management, Client Engagement, Compliance, and Government Programs to participating pharmacies
• 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
• 5 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

• Strong interpersonal communication skills including conflict resolution and listening
• Advanced ability to problem solve and interpret complex data
• Proficiency within Microsoft applications such as Outlook, Word and Excel
• Enhanced ability to coordinate multiple tasks and projects simultaneously under strict timelines
• Ability to work in fast-paced, collaborative team environment
• Enhanced ability to establish rapport and effectively influence at all levels within an organization

Preferred Qualifications

• Experience with multimedia systems such as videos or podcasts for effective training
• Experience analyzing state and federal regulations
• Experience working with RxClaim system or other claims processing experience
• Pharmacy Technician certification (CPhT) or equivalent pharmacy experience

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 $57,600.00 - $86,800.00 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.