Pharmacy Network Administrator - Remote in the California market

Prime Therapeutics • Tallahassee, FL

457d • $43,181 - $64,771 • Remote

About The Position

The Pharmacy Network Administrator serves as a key resource for credentialing and contracting projects within the pharmacy network, focusing on resolving barriers and implementing solutions to meet requirements. This remote position in the California market involves managing various projects, liaising with internal and external stakeholders, and supporting the development of pharmacy networks.

Requirements

• 1-3 years of experience in data management, credentialing, claims, insurance administration, or healthcare setting.
• Strong analysis and problem-solving skills.
• Ability to interface with multi-disciplinary high-level professionals.
• Ability to identify barriers and elevate issues effectively.
• Strong interpersonal and communication skills, both written and verbal.
• Ability to establish strong relationships and influence work performance of others.
• Intermediate MS Excel and strong skills in other MS Office products.

Nice To Haves

• Bachelor's degree preferred.
• Experience in Pharmacy Benefits Management (PBM), managed care, or behavioral health preferred.
• Experience utilizing quality improvement methodologies preferred.

Responsibilities

• Manage credentialing and contracting projects, coordinating with third-party vendors and provider communications.
• Create, design, test, and implement production and audit reports.
• Set up and support pharmacy payment centers and manage contract rollouts.
• Serve as a liaison to field staff for geographic locations, resolving provider issues and complaints.
• Coordinate state Fee For Service client's pharmacy network enrollment as assigned.
• Handle EFT and 835 remittance enrollment and issue resolution.
• Facilitate problem resolution in areas of risk and communicate concerns from field staff and state client contacts.
• Assist in developing commercial pharmacy networks and managing network databases.

Benefits

• Health insurance
• Dental insurance
• Vision insurance
• 401k plan
• Paid holidays
• Paid time off
• Flexible scheduling
• Professional development opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Administrative and Support Services
• Education Level: High school or GED