Senior Provider Relations Analyst – Contract Negotiation
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Job Description
Senior analyst managing independent pharmacy provider contracts for Prime Therapeutics, a pharmacy benefit management company. Resolving contract inquiries, compliance issues, and provider grievances.
Responsibilities:
- Manage Prime’s independent pharmacy network contracting activities
- Research and resolve pharmacy contract-related inquiries
- Evaluate network participation and distribute pharmacy contract documents
- Coordinate timely, accurate, and complete submission, tracking, storage, and distribution of contract deliverables
- Ensure contractual obligations comply with company policies, regulatory requirements, and legal requirements
- Engage Legal and Network Management leadership to ensure contract language is accurate and concise
- Establish, develop, and maintain relationships with independent pharmacy providers
- Manage legal-to-legal correspondence between Prime and independent pharmacy providers, escalating to Prime Legal Counsel as needed
- Conduct root cause analysis of pharmacy contract and pricing-analysis complaints and issues
- Evaluate pharmacy complaints, issues, and grievances and collaborate with Network Management, Client Engagement, and Benefit Operations
- Manage and edit Prime’s Provider Manual for compliance and timely distribution
- Contribute to process improvements supporting cross-functional projects, regulatory changes, and client implementations
- Perform other duties as assigned
Requirements:
- Bachelor's degree in Business or related area of study, or equivalent combination of education and/or relevant work experience
- High school diploma or GED required
- 5 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 work visa or residency sponsorship
- Strong interpersonal communication skills, including conflict resolution and listening
- Advanced ability to problem solve and interpret complex data
- Proficiency with Microsoft Outlook, Word, and Excel
- Ability to coordinate multiple tasks and projects simultaneously under strict timelines
- Ability to work in a fast-paced, collaborative team environment
- Ability to establish rapport and effectively influence at all organizational levels
- Preferred: experience analyzing state and federal regulations
- Preferred: experience with RxClaim or other claims processing systems
- Preferred: Pharmacy Technician certification (CPhT) or equivalent pharmacy experience
- Preferred: experience negotiating contracts
- Preferred: Salesforce experience
- Preferred: experience reviewing and responding to contract-related questions
- Preferred: familiarity with reviewing and managing contract redlines
- Preferred: experience supporting or coordinating contract execution
- Must comply with job-specific security responsibilities, applicable legal, regulatory, and contractual requirements, and internal policies and procedures
- Must be able to perform the essential functions of the job; reasonable accommodations may be available
Benefits:
- Potential pay based on experience and skills
- Benefits, incentives and additional compensation are available through Prime’s Benefits Page
- Reasonable accommodations for employees with disabilities
- Tobacco-Free Workplace
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