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.
Provider Relations Analyst Sr (Pharmacy Contracting) - Remote
Job Description
The 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 inquiries; 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.
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.
Prime Therapeutics LLC welcomes 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
[email protected].
#J-18808-Ljbffr
