Provider Relations Analyst Sr - Remote
Prime Therapeutics, Pierre, SD, United States
Job Posting Title
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 the independent pharmacy network contracting activities, ensuring contracting initiatives are effective and completed in accordance with network management strategies. It also maintains the Prime Provider Manual, addresses escalated pharmacy inquiries through the Provider Relations email box, and supports related process improvements.
Responsibilities
Research and resolve pharmacy contract related inquiries; evaluate network participation and distribute pharmacy contract documents; coordinate timely, accurate and complete submission of contract deliverables, and electronically and physically track, store and distribute contract documents.
Ensure all contractual obligations adhere to company policies, regulatory compliance and legal requirements; engage with Legal and Network Management leadership to maintain accurate and concise language.
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.
Evaluate pharmacy inquiries—including complaints, issues, and grievances—and collaborate with internal stakeholders such as Network Management, Client Engagement, and Benefit Operations.
Manage and edit Prime’s Provider Manual to ensure compliance and timely distribution; contribute to process improvements that support cross‑functional projects, regulatory changes, and client implementations.
Perform other duties as assigned.
Minimum Qualifications
Bachelor's degree in Business or related area of study, or equivalent combination of education and 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, or Pharmacy Benefit Management.
Must be eligible to work in the United States without the need for 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 with Microsoft applications such as Outlook, Word and Excel.
Ability to coordinate multiple tasks and projects simultaneously under strict timelines.
Ability to work in a fast‑paced, collaborative team environment.
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 or other claims processing systems.
Pharmacy Technician certification (CPhT) or equivalent pharmacy experience.
Experience 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.
Pay Range Potential pay for this position ranges from $66,000.00 - $106,000.00 based on experience and skills.
Equal Employment Opportunity Statement Prime Therapeutics LLC is a proud 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 applicants with arrest and conviction records and those requiring reasonable accommodations, and we are a Tobacco‑Free Workplace employer.
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Job Description The Senior Provider Relations Analyst is responsible for contracting efforts and managing Prime’s independent pharmacy networks. This position manages the independent pharmacy network contracting activities, ensuring contracting initiatives are effective and completed in accordance with network management strategies. It also maintains the Prime Provider Manual, addresses escalated pharmacy inquiries through the Provider Relations email box, and supports related process improvements.
Responsibilities
Research and resolve pharmacy contract related inquiries; evaluate network participation and distribute pharmacy contract documents; coordinate timely, accurate and complete submission of contract deliverables, and electronically and physically track, store and distribute contract documents.
Ensure all contractual obligations adhere to company policies, regulatory compliance and legal requirements; engage with Legal and Network Management leadership to maintain accurate and concise language.
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.
Evaluate pharmacy inquiries—including complaints, issues, and grievances—and collaborate with internal stakeholders such as Network Management, Client Engagement, and Benefit Operations.
Manage and edit Prime’s Provider Manual to ensure compliance and timely distribution; contribute to process improvements that support cross‑functional projects, regulatory changes, and client implementations.
Perform other duties as assigned.
Minimum Qualifications
Bachelor's degree in Business or related area of study, or equivalent combination of education and 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, or Pharmacy Benefit Management.
Must be eligible to work in the United States without the need for 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 with Microsoft applications such as Outlook, Word and Excel.
Ability to coordinate multiple tasks and projects simultaneously under strict timelines.
Ability to work in a fast‑paced, collaborative team environment.
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 or other claims processing systems.
Pharmacy Technician certification (CPhT) or equivalent pharmacy experience.
Experience 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.
Pay Range Potential pay for this position ranges from $66,000.00 - $106,000.00 based on experience and skills.
Equal Employment Opportunity Statement Prime Therapeutics LLC is a proud 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 applicants with arrest and conviction records and those requiring reasonable accommodations, and we are a Tobacco‑Free Workplace employer.
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