Senior Provider Relations Analyst
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Job Description
Senior Provider Relations Analyst responsible for managing pharmacy network contracting at Prime Therapeutics. Focusing on provider relations and compliance within pharmacy operations.
Responsibilities:
- Research and resolve pharmacy contract related inquires; 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
- Ensure all contractual obligations adhere with company policies, regulatory compliance and legal requirements; engage with Legal and Network Management leadership as needed to ensure the language provided is accurate and concise
- Establish, develop, and maintain relationships with independent pharmacy providers
- Manage legal-to-legal correspondences between Prime and independent Pharmacy Providers escalating to Prime Legal Counsel as required
- Conduct root cause analysis, including but not limited to, investigating, monitoring, resolving and reporting for pharmacy contract and pricing analysis complaints issues
- Evaluate pharmacy inquiries to include but not limited to complaints, issues and/or grievances and collaborate with internal stakeholders, such as Network Management, Client Engagement, and Benefit Operation
- Manage and edit Prime’s Provider Manual to ensure compliance and timely distribution, while contributing to process improvements that support cross-functional projects, regulatory changes, and client implementations
- 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, Pharmacy Benefit Management (PBM)
- Must be eligible to work in the United States without the need for work visa or residency sponsorship
- Strong interpersonal communication skills including conflict resolution and listening
- Advanced ability to problem solve and interpret complex data
- Proficiency within Microsoft applications such as Outlook, Word and Excel
- Enhanced ability to coordinate multiple tasks and projects simultaneously under strict timelines
- Ability to work in fast-paced, collaborative team environment
- Enhanced ability to establish rapport and effectively influence at all levels within an organization
Benefits:
- Health insurance
- 401(k) matching
- Flexible work hours
- Paid time off
- Professional development opportunities
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