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.