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.
Job Posting Title
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 inquires received in the Pharmacy Network Management email box.
Responsibilities
Research claims and conduct pharmacy outreach to support regulatory, client commitments and other initiatives as assigned
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
Research, assign and escalate inquiries received through the Pharmacy Provider Relations email box
Process pharmacy remittance requests
Process claims reversals
Resolve prescriber related CMS Prescription Drug Events (PDE) rejections within the required turnaround times
Identify and participate in implementing department level process improvements
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 Manager (PBM)
Must be eligible to work in the United States without need for work visa or residency sponsorship
Additional Qualifications
Demonstrated ability to problem solve complex issues in a timely manner
Excellent 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 ( 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._
Positions will be posted for a minimum of five consecutive workdays.
At Prime Therapeutics (Prime), we are a different kind of PBM. We're reimagining pharmacy solutions to provide the care we would want for our loved ones. That purpose energizes our team and creates limitless opportunities to make a difference.
We know that people make all the difference. If you're ready for a purpose-driven career and are passionate about simplifying health care, let's build the future of pharmacy together.
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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