Sr. Provider Relations Specialist - Remote
Company: Prime Therapeutics
Location: Salem
Posted on: May 26, 2023
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Job Description:
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
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
(https://www.primetherapeutics.com/careers/benefits/) 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.
Keywords: Prime Therapeutics, Salem , Sr. Provider Relations Specialist - Remote, Other , Salem, Oregon
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