Job Description
The Associate Provider Relations Specialist is responsible for conducting outreach to pharmacies participating in Prime’s pharmacy networks and ensuring the information provided during outbound communications is accurate and delivered in a timely manner. This position is responsible for managing extension requests for the claims processing time frame and triaging inquires received in the Pharmacy Network Management email box.
Responsibilities
- Research claims and conduct pharmacy outreach to support regulatory, client commitments and other initiatives as assigned
- Prepare pharmacy outreach reporting to internal and external stakeholders
- Manage and resolve requests to update the transaction control table in order to extend the timely filing
- Research, assign and escalate inquiries received through the Pharmacy Provider Relations email box
- Process pharmacy remittance requests
- Process claims reversals
- Resolve prescriber related CMS Prescription Drug Events (PDE) rejections within the required turnaround times
- Identify and participate in implementing department level process improvements
- Other duties as assigned
Education & Experience
- Associate’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, or Pharmacy Benefit Management (PBM)
- Must be eligible to work in the United States without need for work visa or residency sponsorship
Additional Qualifications
- Demonstrated ability to problem solve complex issues in a timely manner
- Excellent customer service and collaboration skills
- Enhanced organizational skills with the ability to work on multiple tasks simultaneously
- Ability to work with confidential data and maintain privacy
- Ability to evaluate and interpret policies and procedures
- Ability to work in a fast-paced, collaborative team environment
- Advanced in Microsoft applications such as Outlook, Word and Excel
Preferred Qualifications
- Bachelor’s degree in Business or related area of study
- Experience working with RxClaim or other claims processing systems
- Pharmacy Technician certification (CPhT) or equivalent pharmacy experience
- Previous outbound calling experience
Physical Demands
- Ability to work a flexible schedule including shifts outside of Prime’s core business hours of 8:00 a.m. to 4:30 p.m.
- Constantly required to sit, use hands to handle or feel, talk and hear
- Frequently required to reach with hands and arms
- Occasionally required to stand, walk and stoop, kneel, and crouch
- Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
- Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.Potential pay for this position ranges from $23.08 – $37.02 based on experience and skills.