Provider Relations Specialist

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 - Remote **Job Description**: The Provider Relations Specialist is responsible for providing ongoing support to Prime’s participating pharmacies, clients, and internal and external stakeholders. This position is responsible for conducting the necessary claims research for escalated pharmacy and client inquiries, offering issue resolution for claims processing and pharmacy payment in order to resolve inquiries. This position is responsible for the solicitation, initiation and maintenance of independent pharmacy agreements and contract administration by ensuring contract process adherence in alignment with Network Management policies and Records Information Management (RIM). **Responsibilities**: - Serve as primary point of contact for Pharmacies contract related inquires, claims payment and billing inquires, adjustments, EFT set-up and maintenance, and reconciliation vendor set-up and maintenance - Serve as primary point of contact for all pharmacy inquiries and collaborate with internal stakeholders, such as Network Management, Client Engagement, and Benefit Operations to resolve inquiries regarding contracting, payment and billing claims submission requirements, and general benefit information Process claim reversals, drug pricing analysis complaints, chain and Pharmacy Services Administration Organization (PSAO) network updates - Execute regular scheduled tasks including but not limited to, independent contract set up and maintenance, NPCP weekly tape load, returned checks, and claim reversals - 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 and ensure adherence to the records and information management standards for archival and destruction purposes - 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, 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 - Demonstrated ability to problem solve issues timely - Excellent customer service and collaboration skills - Demonstrated ability to problem solve through complex situations - Enhanced organizational skills with the ability to work on multiple tasks simultaneously - Enhanced ability to work with confidential data and maintain privacy - Enhanced ability to evaluate and interpret policies and procedures - Ability to work in a fast-paced, collaborative team environmentPreferred 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 $22.02 - $31.15 based on location, 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.