Pharmacy Network Rep

ProCare Rx•Gainesville, GA

13d•Onsite

About The Position

This role provides day-to-day operational support for pharmacy-related questions via phone and email. The position is responsible for responding to requests and questions from pharmacies in a timely manner, initiating and tracking contracts from initial draft to completion, and providing contractual education. The role also involves targeting and recruiting additional pharmacies to meet network adequacy requirements, participating in re-contracting efforts, and updating multiple systems with contract data and demographic information. Additionally, the position will submit pricing changes, work with the Credentialing Specialist to ensure credentialing standards are met, investigate simple pharmacy claim issues, and communicate with the MAC/Reimbursement team. The role also includes preparing documentation for audits, attending meetings for new plans, ensuring deliverables are met, and coordinating pharmacy network fax/email blasts. Finally, the position is responsible for monthly import reports and weekly data cascading.

Requirements

Must be a strong team player who can adapt to a team environment and work independently in a fast-paced setting.
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 things.
Extreme attention to detail.
Working knowledge of computers and related software applications such as Word, Excel, Adobe, and Outlook.
Must be able to review contracts and learn the differences of each contract.

Nice To Haves

PBM experience a plus.

Responsibilities

Provide day-to-day operational support for pharmacy questions via phone and/or email.
Respond to requests and questions from pharmacies in a timely manner.
Initiate and track contracts from initial draft to full completion.
Provide written and/or verbal contractual education for pharmacies.
Target and recruit additional pharmacies to meet Plan network adequacy requirements.
Participate in re-contracting efforts as required.
Update multiple systems with contract data and demographic information.
Submit pricing changes to the Quality Assurance team.
Work with the Credentialing Specialist to ensure credentialing standards are met.
Investigate simple pharmacy claim issues and help resolve pharmacy issues.
Communicate with the MAC/Reimbursement team.
Prepare documentation for audits, as requested.
Attend meetings for new plan implementations.
Ensure deliverables are on time and meet quality levels as expected.
Coordinate and follow up on pharmacy network fax/email blasts.
Responsible for monthly import reports and weekly cascading of data through various systems.