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Provider Relations Specialist - Remote
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Job Description
- Req#: R-15878
Employer Industry: Pharmacy Benefit Management (PBM)
Why consider this job opportunity:
- Salary up to $94,000.00 based on experience and skills
- Opportunity for career advancement and growth within the organization
- Work remotely with flexible scheduling options
- Supportive and collaborative work environment
- Chance to make a positive impact on pharmacy operations and client satisfaction
What to Expect (Job Responsibilities):
- Research pharmacy inquiries received through the Provider Relations email and phone lines, collaborating with internal stakeholders for resolution
- Manage and draft provider communication from internal stakeholders
- Evaluate pharmacy claims payment and billing inquiries, including EFT set-up and maintenance
- Conduct root cause analysis for grievances initiated by the Government Programs Research Team (GPRT)
- Maintain updates for the Chain and Pharmacy Services Administration Organization (PSAO) network and contribute to process improvements
What is Required (Qualifications):
- 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
- Minimum of 2 years 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 a work visa or residency sponsorship
- Strong verbal and written presentation skills
- Proficiency in Microsoft Word and Microsoft Excel
How to Stand Out (Preferred Qualifications):
- Experience working with the RxClaim system or other claims processing experience
- Pharmacy Technician certification (CPhT) or equivalent pharmacy experience
- Experience using Contract Management software including maintaining and managing databases
- Pharmacy outreach and outbound call experience
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