Provider Relations Analyst Sr – Remote
Prime Therapeutics, Des Moines, IA, 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 Analyst Sr – Remote Job Description The Senior Provider Relations Analyst is responsible for contracting efforts and managing Prime’s independent pharmacy networks. This position manages Prime’s network contracting activities, ensuring initiatives are effective and completed in accordance with network management strategies. It also manages and maintains the Prime Provider Manual, resolves escalated pharmacy inquiries through the Provider Relations email box, and coordinates with legal and network management leadership.
Responsibilities
Research and resolve pharmacy contract related inquiries; evaluate network participation and distribute contract documents; coordinate the 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 to 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 investigating, monitoring, resolving and reporting pharmacy contract and pricing analysis complaints issues.
Evaluate pharmacy inquiries to include 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).
Eligibility 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 interpret complex data.
Proficiency within Microsoft applications such as Outlook, Word and Excel.
Enhanced ability to coordinate multiple tasks and projects simultaneously under strict timelines.
Ability to work in a fast‑paced, collaborative team environment.
Enhanced ability to establish rapport and effectively influence at all levels within an organization.
Preferred Qualifications
Experience analyzing state and federal regulations.
Experience working with RxClaim system or other claims processing experience.
Pharmacy Technician certification (CPhT) or equivalent pharmacy experience.
Experience with negotiating contracts.
Salesforce experience.
Experience reviewing and responding to questions related to contracts.
Familiarity with reviewing and managing contract redlines.
Experience supporting or coordinating the execution of contracts.
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.
Potential pay for this position ranges from $66,000.00 – $106,000.00 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 (https://www.primetherapeutics.com/benefits).
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 Analyst Sr – Remote Job Description The Senior Provider Relations Analyst is responsible for contracting efforts and managing Prime’s independent pharmacy networks. This position manages Prime’s network contracting activities, ensuring initiatives are effective and completed in accordance with network management strategies. It also manages and maintains the Prime Provider Manual, resolves escalated pharmacy inquiries through the Provider Relations email box, and coordinates with legal and network management leadership.
Responsibilities
Research and resolve pharmacy contract related inquiries; evaluate network participation and distribute contract documents; coordinate the 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 to 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 investigating, monitoring, resolving and reporting pharmacy contract and pricing analysis complaints issues.
Evaluate pharmacy inquiries to include 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).
Eligibility 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 interpret complex data.
Proficiency within Microsoft applications such as Outlook, Word and Excel.
Enhanced ability to coordinate multiple tasks and projects simultaneously under strict timelines.
Ability to work in a fast‑paced, collaborative team environment.
Enhanced ability to establish rapport and effectively influence at all levels within an organization.
Preferred Qualifications
Experience analyzing state and federal regulations.
Experience working with RxClaim system or other claims processing experience.
Pharmacy Technician certification (CPhT) or equivalent pharmacy experience.
Experience with negotiating contracts.
Salesforce experience.
Experience reviewing and responding to questions related to contracts.
Familiarity with reviewing and managing contract redlines.
Experience supporting or coordinating the execution of contracts.
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.
Potential pay for this position ranges from $66,000.00 – $106,000.00 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 (https://www.primetherapeutics.com/benefits).
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