Senior Provider Relations Analyst – Contract Negotiation

🔥 3 hours ago

🇺🇸 United States – Remote

💵 $66k - $106k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

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Prime Therapeutics

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1998

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Prime Therapeutics is a trusted pharmacy solutions provider dedicated to transforming health care through innovation and transparency. The company offers a wide range of services including clinical solutions for improved member outcomes, drug access and affordability, specialty drug management, and condition management for chronic health issues. With over 7,000 employees, Prime Therapeutics aims to challenge norms in the pharmacy industry, providing exceptional experiences and simplifying the complex for millions across the nation. Their mission goes beyond profit, focusing on creating transformative impacts with long-term solutions, utilizing modern technology and holistic approaches in specialty pharmacy management. Owned by mission-driven partners, Prime Therapeutics emphasizes true transparency and conflict-free service, fostering a culture of care and shared purpose in health care.

📋 Description

• Manage Prime’s independent pharmacy network contracting activities • Research and resolve pharmacy contract-related inquiries • Evaluate network participation and distribute pharmacy contract documents • Coordinate timely, accurate, and complete submission, tracking, storage, and distribution of contract deliverables • Ensure contractual obligations comply with company policies, regulatory requirements, and legal requirements • Engage Legal and Network Management leadership to ensure contract language is accurate and concise • Establish, develop, and maintain relationships with independent pharmacy providers • Manage legal-to-legal correspondence between Prime and independent pharmacy providers, escalating to Prime Legal Counsel as needed • Conduct root cause analysis of pharmacy contract and pricing-analysis complaints and issues • Evaluate pharmacy complaints, issues, and grievances and collaborate with Network Management, Client Engagement, and Benefit Operations • Manage and edit Prime’s Provider Manual for compliance and timely distribution • Contribute to process improvements supporting cross-functional projects, regulatory changes, and client implementations • Perform other duties as assigned

🎯 Requirements

• 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, or Pharmacy Benefit Management (PBM) • Must be eligible to work in the United States without work visa or residency sponsorship • Strong interpersonal communication skills, including conflict resolution and listening • Advanced ability to problem solve and interpret complex data • Proficiency with Microsoft Outlook, Word, and Excel • Ability to coordinate multiple tasks and projects simultaneously under strict timelines • Ability to work in a fast-paced, collaborative team environment • Ability to establish rapport and effectively influence at all organizational levels • Preferred: experience analyzing state and federal regulations • Preferred: experience with RxClaim or other claims processing systems • Preferred: Pharmacy Technician certification (CPhT) or equivalent pharmacy experience • Preferred: experience negotiating contracts • Preferred: Salesforce experience • Preferred: experience reviewing and responding to contract-related questions • Preferred: familiarity with reviewing and managing contract redlines • Preferred: experience supporting or coordinating contract execution • Must comply with job-specific security responsibilities, applicable legal, regulatory, and contractual requirements, and internal policies and procedures • Must be able to perform the essential functions of the job; reasonable accommodations may be available

🏖️ Benefits

• Potential pay based on experience and skills • Benefits, incentives and additional compensation are available through Prime’s Benefits Page • Reasonable accommodations for employees with disabilities • Tobacco-Free Workplace