Provider Relations Specialist Associate - 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.

Job Posting Title

Provider Relations Specialist Associate - Remote

Job Description

The Associate Provider Relations Specialist is responsible for conducting outreach to pharmacies participating in Prime's pharmacy networks and ensuring the information provided during outbound communications is accurate and delivered in a timely manner. This position is responsible for managing extension requests for the claims processing time frame and triaging inquires received in the Pharmacy Network Management email box.

Responsibilities

• Research claims and conduct pharmacy outreach to support regulatory, client commitments and other initiatives as assigned
• Prepare pharmacy outreach reporting to internal and external stakeholders
• Manage and resolve requests to update the transaction control table in order to extend the timely filing
• Research, assign and escalate inquiries received through the Pharmacy Provider Relations email box
• Process pharmacy remittance requests
• Process claims reversals
• Resolve prescriber related CMS Prescription Drug Events (PDE) rejections within the required turnaround times
• 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
• 1 year of work experience in a call center, customer service, operations, retail pharmacy, pharmacy technician, or Pharmacy Benefit Manager (PBM)
• Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

• Demonstrated ability to problem solve complex issues in a timely manner
• Excellent customer service and collaboration skills
• Enhanced organizational skills with the ability to work on multiple tasks simultaneously
• Ability to work with confidential data and maintain privacy
• Ability to evaluate and interpret policies and procedures
• Ability to work in a fast-paced, collaborative team environment
• Advanced in Microsoft applications such as Outlook, Word and Excel

Preferred Qualifications

• Experience working with RxClaim or other claims processing systems
• Pharmacy Technician certification (CPhT) or equivalent pharmacy experience
• 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 $23.08 - $37.02 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.

Positions will be posted for a minimum of five consecutive workdays.