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Provider Relations Contract Analyst

 
Provider Relations Contract Analyst

ESSENTIAL DUTIES AND RESPONSIBILITIES:
  • Manage pharmacy contracting process with independent pharmacies and select chains/PSAOs and assist management with complex network negotiations
  • Perform pharmacy network testing and review to ensure compliance with pharmacy network agreements
  • Research and problem solve to resolve claim issues and concerns
  • Manage requests, inquires, 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
  • Manage additional network initiatives as identified
  • Develop and maintain a working knowledge of retail, mail order, specialty, in-house, long term care, home infusion, and other pharmacies
  • 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
·      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.