[Remote] Provider Relations Specialist Associate - Remote
Note: The job is a remote job and is open to candidates in USA. Prime Therapeutics is a unique PBM focused on connecting care for those they serve. The Associate Provider Relations Specialist will conduct outreach to pharmacies, manage claims processing requests, and ensure accurate communication within the pharmacy networks.
Responsibilities
- Research and resolve claims and conduct pharmacy outreach to support regulatory, client commitments and other initiatives as assigned
- Research and escalate inquiries received through the Pharmacy Provider Relations email box
- Process claims reversals
- Identify and participate in implementing department level process improvements
- 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
- 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
- 1 year of work experience in a call center, customer service, operations, retail pharmacy, pharmacy technician, or Pharmacy Benefit Management (PBM)
- Must be eligible to work in the United States without the need for work visa or residency sponsorship
- Demonstrated ability to problem solve complex issues in a timely manner
- Strong 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
- Experience working with RxClaim or other claims processing systems
- Pharmacy Technician certification (CPhT) or equivalent pharmacy experience
- Pharmacy outreach and outbound call experience
Company Overview