Senior Provider Relations Specialist

4 weeks ago


Des Moines, Iowa, United States Prime Therapeutics Full time
Job Description

Prime Therapeutics is seeking a highly skilled Senior Provider Relations Specialist to join our team. As a key member of our Provider Relations team, you will be responsible for managing contracting efforts for low to mid complexity pharmacies. This role requires strong communication and problem-solving skills, as well as the ability to work independently and as part of a collaborative team.

Key Responsibilities
  • Conduct root cause analysis to investigate, monitor, resolve, and report on pharmacy contract issues, grievances, and CMS Prescription Drug Events (PDE) rejections.
  • Serve as a primary point of contact for electronic transaction file set-up and maintenance.
  • Collaborate with key pharmacy chains, Network Management, Client Engagement, Finance, and Benefit Operations to resolve escalated issues and complete root cause analysis.
  • Draft and manage communication efforts on behalf of Network Management, Client Engagement, Compliance, and Government Programs to participating pharmacies.
  • Identify trends in escalated pharmacy issues and develop strategies to enhance processes and reduce the number of escalated pharmacy issues.
Requirements
  • Bachelor'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, Pharmacy Benefit Management (PBM), or other relevant experience in a related industry.
  • Must be eligible to work in the United States without need for work visa or residency sponsorship.
Preferred Qualifications
  • Experience working with RxClaim system or other claims processing experience.
  • Pharmacy Technician certification (CPhT) or equivalent pharmacy experience.
  • Experience using Contract Management software including maintaining and managing databases.


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