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
Pharmacy Network Administrator - Remote in the California market
Job Description Summary
Serves as the departmental resource for assigned credentialing and contracting projects. Projects range from basic to moderate complexity. Using advanced systems knowledge and provider credentialing/contracting information, identifies barriers impacting on meeting credentialing and contracting requirements, develops strategies for resolution and facilitates implementation of a solution. Serves as liaison for external and internal customers of the Credentialing/Contracting Administration and payment center information.
Job Description
- Manages a variety of credentialing and contracting projects including but not limited to coordination with third-party vendors; provider communications and liaison; creation, design, testing and implementation of specific production and audit reports; pharmacy payment center setup and support; contract rollout and special mailings.
- Serves as liaison to field staff for all assigned geographic locations utilizing knowledge of credentialing and contracting information and network structure to resolve problems, complaints, appeals and other provider issues.
- Coordinates state Fee For Service client's pharmacy network enrollment as assigned.
- Coordinates all EFT and 835 remittance enrollment and issue resolution.
- Coordinates problem resolution in areas of risk, facilitate prioritization of production, and communicates concerns from field staff and State client contacts.
- Assists with the development of commercial pharmacy networks within adjudication systems, network database management, communications database management and RFP responses as assigned by management
- Performs other duties as assigned.
Responsibilities
- 1-3 years of experience in data management, credentialing, claims, insurance administration or health care setting or on the job equivalent required.
- Analysis and problem solving skills required.
- Ability to interface with multi-disciplinary high level professionals.
- Ability to identify barriers and elevate issues.
- Strong interpersonal and communication skills, both written and verbal.
- Ability to establish strong relationships and influence work performance of others.
- Intermediate MS Excel and strong skills in other MS Office products.
- Bachelors degree preferred.
- Pharmacy Benefits Management (PBM), managed care or behavioral health experience preferred.
- Experience utilizing quality improvement methodologies preferred.
Work Experience
Work Experience - Required:
Claims, Healthcare
Work Experience - Preferred:
Education
Education - Required:
GED, High School
Education - Preferred:
Bachelors
Certifications
Certifications - Required:
Certifications - Preferred:
Potential pay for this position ranges from $20.76 - $31.14 based on experience and skills. Pay range may vary by 8% depending on applicant location.
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, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by 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.
