At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.
Job Posting Title
Job Description
The Senior Provider Relations Analyst is responsible for contracting efforts and managing Prime’s independent pharmacy networks. This position is responsible for the management of Prime’s independent pharmacy network contracting activities, ensuring contracting initiatives are effective and completed in accordance with network management strategies. In addition, this position manages and maintains the Prime Provider Manual, issues resolution for escalated pharmacies inquiries through the Provider Relations email box.
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
Minimum Qualifications
- 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
Additional Qualifications
- Strong interpersonal communication skills including conflict resolution and listening
- Advanced ability to problem solve and