Provider Relations Specialist Associate (Remote)
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
Provider Relations Specialist Associate (Remote)Job Description
The 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
Associate'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, or Pharmacy Benefit Management (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
Bachelor's degree in Business or related area of study
Experience working with RxClaim or other claims processing systems
Pharmacy Technician certification (CPhT) or equivalent pharmacy experience
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
Reports to Manager in the Network Management department
Potential pay for this position ranges from $23.08 - $37.02 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.
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, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by 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.
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