Specialty Accounts Coordinator, Payer Relations

Pantherx Specialty LLC

99d

About The Position

The Specialty Accounts Coordinator, Payer Relations, serves as the primary liaison between PANTHERx internal teams and payers, focusing on the resolution of claim-specific issues to ensure timely outcomes that safeguard patient access to therapy. Success in this role requires strong technical expertise in pharmacy claim processing, exceptional organizational and communication skills, proactive problem-solving, and a passion for patient advocacy to prevent therapy disruption. This is a remote role with occasional travel required to PANTHERx headquarters or as needed in support of Payer Relations.

Requirements

• Bachelor’s degree in Healthcare, Pharmacy, Business, or related field preferred; equivalent work experience may be considered in lieu of a degree.
• Minimum of two (2) years of experience in specialty pharmacy, pharmacy benefit management, claims processing, or related healthcare role.
• Proven success working within pharmacy/claims management platforms.
• Strong understanding of pharmacy benefit design, prior authorization processes, and pharmacy claim processing with a proven ability to navigate complex payer systems and policies with confidence.
• Strong sense of accountability and urgency in resolving claim issues.
• Ability to translate complex issues into clear, concise requests for action.
• Excellent written and verbal communication skills, with the ability to convey urgency and advocate for patients.
• Highly organized, detail-oriented, and able to manage multiple priorities in a fast-paced environment.
• Demonstrated passion for patient care and persistence in problem-solving.

Nice To Haves

• Project management experience.

Responsibilities

• Manages day-to-day claims issues within multiple payer-related queues.
• Utilizes internal adjudication systems to identify and extract key patient claim details (e.g., patient demographics, BIN, PCN, Group, ID, Rx#, drug name, PA denial info, etc.).
• Compiles patient claim information and effectively translate findings to payers via secure email.
• Prioritizes claims where patients are at risk of therapy interruption.
• Voices urgency and advocates directly with payer claim teams to expedite resolution.
• Follows up with payers based on urgency level to ensure timely decisions.
• Escalates to payer relations leadership when appropriate.
• Partners with Operations, Finance, and Revenue Cycle Management (RCM) teams to ensure payer determinations are applied correctly.
• Attends daily launch meetings with program management to review and escalate payer-related rejected claims.
• Documents all outreach and updates in internal systems to maintain visibility and continuity across teams.
• Applies strong knowledge of claims processing workflows, including DAW codes, generic substitution laws, and limited distribution drug (LDD) network access.
• Occasional travel to PANTHER headquarters or other locations as required.
• Other duties as required.

Benefits

• Hybrid, remote and flexible on-site work schedules are available, based on the position.
• Excellent benefit package, including medical, dental, vision, health savings and flexible spending accounts.
• 401K with employer matching.
• Employer-paid life insurance and short/long term disability coverage.
• Employee Assistance Program.
• Generous paid time off for full-time employees, as well as limited paid time off for part-time employees.
• Paid holidays.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Bachelor's degree