Job details
Job type full-time
Not provided by employer
Full job description
Essential duties and responsibilities:
Manage pharmacy contracting process with independent pharmacies and select chains/psaos and assist management with network negotiations
Perform pharmacy network testing and review to ensure compliance with pharmacy network agreements
Support pharmacy audits and network compliance initiatives
Support daily credentialing, re-credentialing, and contracting operations
Implement changes to ensure compliance with all company policies and procedures as well as regulatory requirements
Research and problem solve to resolve claim issues and concerns
Respond to and track requests, inquiries, and communications with network pharmacies
Collaborate with cross-functional teams on pharmacy-related matters
Develop, review and distribute pharmacy communications to meet internal and client requests
Investigate specific issues related to regulatory requirements through literature or internet resources
Resolve dissatisfaction among providers within limits of authority
Maintain current provider data to ensure the quality of the network
Monitor, track, and report pharmacy compliance with guiding government regulations and internal policies and procedures
Track project tasks and deliverables to ensure timelines are met
Other duties as assigned
Requirements:
Bachelor’s degree in health administration, business or related field; proven industry experience will be acceptable in lieu of degree
Ability to independently identify, research and resolve issues
An intelligent and articulate individual who can relate to people at all levels of an organization and possesses excellent communication skills
Sound technical skills, good judgment, and strong operational focus
A decisive individual who possesses a detail oriented perspective
Ability to lead and work with peers in a team effort
Demonstrated ability to manage multiple priorities and deadlines
A well-organized and self-directed individual who is able to work with minimal amount of supervision
Capability to efficiently complete tasks in a fast paced environment
Proficient in microsoft office and industry related software programs
Ability to work extended hours, weekends, and holidays pursuant with industry demands
Preferred qualifications:
Insurance, pharmacy and/or healthcare contracting and/or claims experience
Certified, licensed, or registered pharmacy technician
Data query, analysis and presentation skills
Project management experience
Work environment: includes a typical office environment, with minimal exposure to excessive noise or adverse environmental issues.
Physical requirements: ability to sit for prolonged periods of time.
Equal opportunity employer/protected veterans/individuals with disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicantHowever, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information41 cfr 60-1.35(c)
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Posted 25 days ago
