Top 958 Claims Rep Jobs

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Pharmacy Network Rep

ProCare Rx -
Gainesville, GA

Quick Apply

Job Details

Full-time

Qualifications

Contract documentation review
Contract review
Contract interpretation
Research
Desktop applications
Document viewing software

Full Job Description

ESSENTIAL DUTIES AND RESPONSIBLITIES include but are not limited to the following:
● Ensure pharmacy networks comply with state-specific pharmacy regulations and communicate the regulatory changes to
internal & external stakeholders
● Assist with the implementation of new requirements while functioning as the internal subject matter expert (SME) on state
requirements that may affect pharmacy operations and participation while assisting with the implementation of state
requirements.
● Work with the Legal and Compliance team to assist with regulatory state audits, Corrective action plans and reporting.
● Guarantee pharmacy networks and operational processes are in alignment with state rules and regulations
● Provide day-to-day operational support for pharmacy questions via phone and/or email.
● Responsible for Pharmacy Relations emails; respond to requests and questions from pharmacies in a timely manner.
● Initiate and tracks contract from initial draft to full execution.
● Provide written and/or verbal contractual education for pharmacies as needed.
● Target and recruit additional pharmacies to meet Plan network adequacy requirements and/or requests.
● Participate in re-contracting efforts as required and directed.
● Update multiple systems with contract data and demographic information, as required.
● Submit pricing changes to the Quality Assurance team.
● Preform pharmacy research to ensure company credentialing standards are met.
● Investigate simple pharmacy claim issues, help resolve pharmacy issues and complaints.
● Communicate with the MAC/Reimbursement team as required.
● Prepare documentation for audits, as requested by manager.
● Attend meetings for new plan implementations.
● Ensure deliverables are on time and meet quality levels as expected by ProCare’s internal and external customers.
● Coordinate and follow up on pharmacy network fax/email blasts as required.
● Responsible for monthly import reports and weekly cascading of data through various systems.

● Must have the ability to interpret regulatory language and translate the regulatory changes into operational requirement
● Knowledge of state pharmacy regulations is helpful.
● Must be a strong team player who can adapt to a team environment and work independently in a fast-paced environment.
● Must be able to work in multiple computer systems simultaneously on a daily basis.
● Excellent telephone etiquette and verbal/written communication skills.
● Must be highly organized, motivated, take initiative and possess a willingness to learn new processes.
● Extreme attention to detail required.
● Working knowledge of computers and related software applications such as Word, Excel, Adobe and Outlook a must.
● Must be able to review contracts and learn the differences of each contract.

EDUCATION AND EXPERIENCE

Associate’s Degree with two years of experience in a health care setting working with contracts, regulatory compliance and/or
provider relations preferred. PBM experience a plus.

PHYSICAN DEMANDS
Requires sitting, standing, and occasional light lifting.

This is a full-time position with benefits. Please visit our Contact Us/Opportunities page on our website for more information about our benefits list.

ProCareRx will never ask for a financial commitment from an applicant, as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our official recruitment team at [email protected] (mailto:[email protected]).

ProCareRx is an Equal Opportunity Employer.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

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CUSTOMER SERVICE REP

RCM Cust Svc Support Rep - Remote - Patient Billing (Sourcing)

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