Specialist, Pharmacy Relations

3 weeks ago

Madison, United States Navitus Health Solutions LLC Full time
Job DescriptionJob Description

Job Summary:

The Pharmacy Relations Specialist (PRS) is a highly motivated professional with at least 3 years of successful experience working in a pharmacy or interfacing directly with pharmacies or accounts, preferably in healthcare. Responsibilities include executing contracts with pharmacies, responding to pharmacy inquiries and completing the tactical and operational tasks required to maintain contracted pharmacy networks.

The individual(s) in this position are responsible for provider relations and is the face of Navitus to our pharmacy providers. The individual(s) will also support internal associates, such as customer care and client services, to ensure pharmacies adjudicate pharmacy claims according to Navitus agreements and Navitus business rules. As part of the daily responsibilities, this position is responsible for establishing contracts with pharmacy providers, recording data with a high level of accuracy, researching pharmacy inquiries, and reporting performance metrics.

Job Responsibilities:

  • Make decisions regarding the resolution of pharmacy issues.
  • Establish and maintain contracts with pharmacy providers.
  • Facilitate submittal, receipt, tracking, and process flow of contracts between Navitus and providers.
  • Accurately enter information and maintain contract database.
  • Generate reports on network performance to monitor the claims accuracy throughout the terms of the contract.
  • Responsible for creating networks based on the contract terms within the claims processing system and ensure accuracy with performing quality reviews.
  • Assists in resolving intricate pharmacy provider issues and complaints.
  • Research problems and collaborates with internal/external partners to resolve escalated issues.
  • Engage in research and implementation of legal and compliance requirements.
  • Perform quality assurance to ensure accuracy in pricing and processes.
  • Assist with internal department and corporate projects as required.
  • Coordinate pharmacy network communication efforts including collection of content, disseminating information to provider partners through appropriate channels, and tracking response metrics.
  • Assist in all external delegation and financial audits of the pharmacy network pharmacies.
  • Review internal policy and procedures and manage review dates within the department.
  • Work with minimal guidance
  • Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.
  • Other duties as assigned.

Essential Background Requirements:

Education: College or 2-year Technical Degree or equivalent experience is preferred. Advanced technical education a plus.

  • Certification/Licenses: Certified Pharmacy Technician license preferred.

  • Experience:
    • 1-3 years of successful experience in a customer service role
    • Knowledge of PBM or health care industry preferred.
    • PC skills: Microsoft Office, Email, Internet, and other applications as require.

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