[Remote] Provider Relations Analyst Sr (Contract Negotiation) - Remote

Note: The job is a remote job and is open to candidates in USA. Prime Therapeutics is a unique pharmacy benefit manager focused on connecting care for those they serve. They are seeking a Provider Relations Analyst Sr to manage contracting efforts and oversee the independent pharmacy networks, ensuring compliance with company policies and regulatory requirements.

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

Skills

• 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
• 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
• 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

Benefits

• To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

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