Pharmacy Relations Specialist II
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Job Description
Pharmacy relations specialist at Navitus, a pharmacy benefit manager reducing drug-supply-chain costs. Managing pharmacy contracts, compliance, claims issues, and network operations.
Responsibilities:
- Manage pharmacy contracting process with independent pharmacies and select chains/PSAOs and assist management with network negotiations, including redline reviews
- Review pharmacy contract setup to ensure compliance with pharmacy network agreements
- Support pharmacy audits and network compliance initiatives
- Research and problem solve to resolve claim issues and concerns
- Respond to and track requests, inquiries, and communications with network pharmacies
- Develop, review, and distribute pharmacy communications to meet internal and client requests
- Monitor, track, and report pharmacy compliance with guiding government regulations and internal policies and procedures
- Review and respond to independent pharmacy redlines with little to no input from senior leadership
- Maintain pharmacy network functions, including network plan design builds, quality assurance measures, and claims processing
- Perform other duties as assigned
Requirements:
- At least 2 years of successful experience working in a pharmacy or interfacing directly with pharmacies or accounts, preferably in healthcare
- College or 2-year Technical Degree or equivalent experience is preferred
- Advanced technical education a plus
- Certified Pharmacy Technician preferred
- 3 years business-setting experience
- Retail pharmacy experience or experience in a managed care pharmacy setting desired
- Prior experience analyzing medical and/or pharmacy claims or credentials are highly desired
- Proficient in Microsoft Office and industry related software
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
Benefits:
- Top of the industry benefits for Health, Dental, and Vision insurance
- 20 days paid time off
- 4 weeks paid parental leave
- 9 paid holidays
- 401K company match of up to 5% - No vesting requirement
- Adoption Assistance Program
- Flexible Spending Account
- Educational Assistance Plan and Professional Membership assistance
- Referral Bonus Program – up to $750!
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