Provider Relations Specialist - Remote

Provider Relations Specialist - Remote

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.

The Provider Relations Specialist is responsible for providing ongoing support to Prime's participating pharmacies, clients, and internal and external stakeholders. The role conducts 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 all pharmacy inquiries received through the Provider Relations email box and phone lines and collaborate with internal stakeholders to resolve as needed; also includes drug pricing analysis complaints and pharmacy remittance requests.

Manage and draft provider communication from internal stakeholders.

Evaluate pharmacy claims payment and billing inquires, EFT set-up and maintenance, and reconciliation vendor set-up and maintenance.

Process and maintain electronic transaction file set-up.

Conduct root cause analysis, including but not limited to, investigating, monitoring, resolving and reporting for grievances initiated by Government Programs Research Team (GPRT).

Maintain Chain and Pharmacy Services Administration Organization (PSAO) network updates and contribute to 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; High school diploma or GED required.

2 years of work experience in a call center, customer service, operations, retail pharmacy, pharmacy technician, or Pharmacy Benefit Management (PBM). 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.

Strong 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.

Pharmacy outreach and outbound call experience.

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 $59,000.00 - $94,000.00 based on experience and skills.

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.

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.