Provider Relations Specialist - Remote

PRIME Therapeutics Remote
provider relations relations remote pharmacy management maintenance people provider relations relations stakeholders administration information management billing
December 20, 2022
PRIME Therapeutics
Denver, Colorado
Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Provider Relations Specialist - Remote
Job Description
The Provider Relations Specialist is responsible for providing ongoing support to Prime's participating pharmacies, clients, and internal and external stakeholders. This position is responsible for conducting the necessary claims research for escalated pharmacy and client inquiries, offering issue resolution for claims processing and pharmacy payment in order to resolve inquiries. This position is responsible for the solicitation, initiation and maintenance of independent pharmacy agreements and contract administration by ensuring contract process adherence in alignment with Network Management policies and Records Information Management (RIM).

Serve as primary point of contact for Pharmacies contract related inquires, claims payment and billing inquires, adjustments, EFT set-up and maintenance, and reconciliation vendor set-up and maintenance

Serve as primary point of contact for all pharmacy inquiries and collaborate with internal stakeholders, such as Network Management, Client Engagement, and Benefit Operations to resolve inquiries regarding contracting, payment and billing claims submission requirements, and general benefit information

Monitor, respond to, and escalate inquiries received through the Network Management email box and phone lines in a timely and professional manner

Process claim reversals, drug pricing analysis complaints, chain and Pharmacy Services Administration Organization (PSAO) network updates

Execute regular scheduled tasks including but not limited to, independent contract set up and maintenance, NPCP weekly tape load, returned checks, and claim reversals

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 and ensure adherence to the records and information management standards for archival and destruction purposes

Identify and participate in implementing department level process improvements

Other duties as assigned
Minimum Qualifications

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, Pharmacy Benefit Management (PBM) or other relevant experience in a related industry

Must be eligible to work in the United States without need for work visa or residency sponsorship
Additional Qualifications

Demonstrated ability to problem solve issues timely

Excellent customer service and collaboration skills

Demonstrated ability to problem solve through complex situations

Enhanced organizational skills with the ability to work on multiple tasks simultaneously

Enhanced ability to work with confidential data and maintain privacy

Enhanced 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
Minimum Physical Job Requirements

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
Reporting Structure

Reports to Manager in the Network Management department
Potential pay for this position ranges from $22.02 - $31.15 based on location, experience and skills.
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https:
// and click on the Benefits at a glance button for more detail.
_Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law._
Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.
If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.
Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. 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 [email protected] Salary: $20 to $28 per hour based on qualifications.

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