Prime Therapeutics

Provider Relations Analyst Sr (Contract Negotiation) - Remote

Prime Therapeutics$66K — $106K *
US-AnywhereRemote in United States
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's degree in Business or related field, or equivalent experience
  • 5 years of experience in a call center, customer service, operations, retail pharmacy, or Pharmacy Benefit Management (PBM)
  • Strong interpersonal communication skills, conflict resolution, and listening
  • Advanced problem-solving abilities and capacity to interpret complex data
  • Proficiency in Microsoft applications including Outlook, Word, and Excel

Responsibilities

  • Research and resolve pharmacy contract inquiries; evaluate network participation and distribute contract documents
  • Ensure all contractual obligations comply with company policies and legal requirements; collaborate with Legal and Network Management
  • Establish and maintain relationships with independent pharmacy providers
  • Manage correspondences between Prime and independent pharmacy providers
  • Conduct root cause analysis on pharmacy contract and pricing complaints
  • Evaluate pharmacy inquiries, collaborating with internal stakeholders for resolution
  • Manage and edit the Provider Manual for compliance and timely updates

Benefits

  • Comprehensive health insurance including medical, dental, and vision coverage
  • 401(k) retirement plan with company match
  • Generous paid time off and holiday schedule
  • Professional development opportunities
  • Flexible work environment with remote options
Full Job Description
Provider Relations Analyst Sr (Contract Negotiation) - Remote The Provider Relations Analyst Sr is responsible for contracting efforts and managing Prime’s independent pharmacy networks. This position is responsible for the management of Prime’s independent pharmacy network contracting activities, ensuring contracting initiatives are effective and completed in accordance with network management strategies. In addition, this position manages and maintains the Prime Provider Manual, issues resolution for escalated pharmacies inquiries through the Provider Relations email box. Responsibilities • Research and resolve pharmacy contract related inquires; 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 • Ensure all contractual obligations adhere with 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 but not limited to, investigating, monitoring, resolving and reporting for pharmacy contract and pricing analysis complaints issues • Evaluate pharmacy inquiries to include but not limited to 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) Must be eligible 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 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 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 $66,000.00 - $106,000.00 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

About Prime Therapeutics

Prime Therapeutics is a pharmacy benefit management company that serves health plans, employers, and government programs. The company was founded in 1998 and is headquartered in Eagan, Minnesota. Prime Therapeutics manages prescription drug benefits for more than 30 million people across the United States. The company's services include claims processing, formulary management, and clinical programs. Prime Therapeutics is owned by 18 Blue Cross and Blue Shield health plans. In 2017, the company reported revenue of $5.3 billion.
Learn more about Prime Therapeutics
Size
4,000 employees
Industry
Founded
1990

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