Provider Relations Specialist Associate - Remote
Prime Therapeutics, Tallahassee, FL, United States
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.
Provider Relations Specialist Associate - Remote 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 inquiries received in the Pharmacy Provider Relations email box.
Responsibilities
Research and resolve claims and conduct pharmacy outreach to support regulatory, client commitments and other initiatives as assigned
Research and elevate inquiries received through the Pharmacy Provider Relations email box
Process claims reversals
Identify and participate in implementing department level process improvements
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
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
1 year 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 the need for work visa or residency sponsorship.
Additional Qualifications
Demonstrated ability to problem solve complex issues in a timely manner
Strong 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
Experience working with RxClaim or other claims processing systems
Pharmacy Technician certification (CPhT) or equivalent pharmacy experience
Pharmacy outreach and outbound call experience
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.
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.
Potential pay for this position ranges from $23.08 - $37.02 based on experience and skills.
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page https://www.primetherapeutics.com/benefits and click on the "Benefits at a glance" button for more detail.
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.
Prime Therapeutics LLC is a Tobacco‑Free Workplace employer.
If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.
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Provider Relations Specialist Associate - Remote 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 inquiries received in the Pharmacy Provider Relations email box.
Responsibilities
Research and resolve claims and conduct pharmacy outreach to support regulatory, client commitments and other initiatives as assigned
Research and elevate inquiries received through the Pharmacy Provider Relations email box
Process claims reversals
Identify and participate in implementing department level process improvements
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
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
1 year 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 the need for work visa or residency sponsorship.
Additional Qualifications
Demonstrated ability to problem solve complex issues in a timely manner
Strong 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
Experience working with RxClaim or other claims processing systems
Pharmacy Technician certification (CPhT) or equivalent pharmacy experience
Pharmacy outreach and outbound call experience
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.
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.
Potential pay for this position ranges from $23.08 - $37.02 based on experience and skills.
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page https://www.primetherapeutics.com/benefits and click on the "Benefits at a glance" button for more detail.
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.
Prime Therapeutics LLC is a Tobacco‑Free Workplace employer.
If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.
#J-18808-Ljbffr