Pharmacy Network Rep

ProCare Rx Career•Gainesville, GA

4d•Onsite

About The Position

The Pharmacy Network Rep ensures pharmacy networks comply with state-specific pharmacy regulations and communicates these changes to stakeholders. This role involves assisting with the implementation of new requirements, acting as an internal subject matter expert on state requirements affecting pharmacy operations and participation, and collaborating with Legal and Compliance teams on audits, corrective action plans, and reporting. The representative guarantees that pharmacy networks and operational processes align with state rules and regulations, provides day-to-day operational support for pharmacy-related questions via phone and email, and manages Pharmacy Relations emails, responding promptly to pharmacy inquiries. Additionally, the role initiates and tracks contracts from draft to execution, provides contractual education to pharmacies, targets and recruits pharmacies to meet network adequacy requirements, participates in re-contracting efforts, and updates systems with contract data and demographic information. The position also involves submitting pricing changes, performing pharmacy research for credentialing standards, investigating and resolving simple pharmacy claim issues and complaints, and communicating with the MAC/Reimbursement team. Preparation of audit documentation, attendance at new plan implementation meetings, and ensuring timely, quality deliverables are also key responsibilities. The role requires coordinating and following up on pharmacy network fax/email blasts, managing monthly import reports, and weekly data cascading through various systems. A critical aspect is the ability to interpret regulatory language and translate it into operational requirements.

Requirements

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.

Nice To Haves

PBM experience a plus.

Responsibilities

Ensure pharmacy networks comply with state-specific pharmacy regulations and communicate 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.
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.
Perform 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.
Interpret regulatory language and translate the regulatory changes into operational requirements.