At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.
Job Posting TitleProvider Relations Analyst Sr (Pharmacy Contracting) - RemoteJob DescriptionThe Provider Relations Analyst Sr is responsible for contracting efforts and managing Prime’s independent pharmacy networks. This position is responsible for the management of Prime’s independent pharmacy network contracting activities, ensuring contracting initiatives are effective and completed in accordance with network management strategies. In addition, this position manages and maintains the Prime Provider Manual, issues resolution for escalated pharmacies inquiries through the Provider Relations email box.
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
- Ensure all contractual obligations adhere with company policies, regulatory compliance and legal requirements; engage with Legal and Network Management leadership as needed to ensure the language provided is accurate and concise
- Establish, develop, and maintain relationships with independent pharmacy providers
- Manage legal-to-legal correspondences between Prime and independent Pharmacy Providers escalating to Prime Legal Counsel as required
- 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
- Manage and edit Prime’s Provider Manual to ensure compliance and timely distribution, while contributing to process improvements that support cross-functional projects, regulatory changes, and client implementations
- 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; High school diploma or GED required
- 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 the 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 analyzing state and federal regulations
- Experience working with RxClaim system or other claims processing experience
- Pharmacy Technician certification (CPhT) or equivalent pharmacy experience
- Experience with negotiating contracts
- Salesforce experience
- Experience reviewing and responding to questions related to contracts
- Familiarity with reviewing and managing contract redlines
- Experience supporting or coordinating the execution of contracts
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
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.
Potential pay for this position ranges from $66,000.00 - $106,000.00 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 (https://www.primetherapeutics.com/benefits).
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 (including pregnancy), 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.
Skills Required
- Bachelor's degree in Business or related area, or equivalent work experience
- 5 years of work experience in call center, customer service, operations, retail pharmacy, or PBM
Prime Therapeutics Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Prime Therapeutics and has not been reviewed or approved by Prime Therapeutics.
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Healthcare Strength — Health coverage is described as comprehensive, with medical, dental, and vision options and plan designs that include low deductibles for some choices. Wellness screenings and related incentives add perceived value to the health offering.
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Retirement Support — Retirement benefits stand out through a 401(k) match that is characterized as generous and immediately vested. This structure improves the overall long-term value of the total rewards package.
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Strong & Reliable Incentives — Annual incentive bonuses are positioned as a meaningful component of total compensation and are often portrayed as substantial when performance goals are met. Incentive eligibility appears broadly available across roles, boosting the perceived completeness of rewards.
Prime Therapeutics Insights
What We Do
Everything we do is connected to helping people get the medicine they need to feel better and live well. It’s meaningful work and we’ve been doing it for over 20 years. In the pharmacy benefit management (PBM)industry, we’re different. We’re owned by 18 not-for-profit Blue Cross and Blue Shield health plans. This allows us to control costs and empower our employees to put members first. It’s a successful combination. We have the lowest pharmacy trend in the industry and serve 28+ million members throughout the US. In addition to core PBM services, we work closely with our clients to implement the right benefit design, clinical and specialty programs, formulary and networks. A few key products: • NetResults™ • Specialty Drug Management • Best in Care™ • GuidedHealth® • Advanced Fraud, Waste and Abuse: Member and Prescriber Investigations • Prime Analytics™ • CareCentered Contracting™Controlled Substance Management Program Join us! Prime is always looking for smart, purposeful people to join our team. We’re growing fast which means there are plenty of opportunities to advance and grow in your career. At the same time, Prime supports flexibility and offers generous PTO so you can enjoy an enviable work/life balance. We’re a privately held company -big enough to make a difference and small enough for you to have an impact. Follow Prime on LinkedIn to learn more.
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