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

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

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.