The Contract Network Representative supports the creation and maintenance of contracts with pharmacy providers. This position also will be responsible for providing support for the development of new pharmacy networks as defined by Prime’s clients, as well as maintain the data integrity of existing executed Agreements.
Minimum Qualifications :
- Assist with contract and negotiation processes. Review modified language within the pharmacy agreements submitted by pharmacy providers, monitor and communicate the progress of new agreements and provide appropriate written communications to the Provider Relations staff about issues identified from the review
- Correspond with pharmacy providers. Communicate, in both verbal and in written form, regarding contract document status, contract amendments, and respond to other inquires
- Maintain contract files and records, including inventory control
- Maintain the tracking of the pharmacy agreements specific terms and conditions
- Assist the Contract Specialist to maintain version control of all agreements. This includes collaborating with the Contract Specialist to amend agreements and/or Pharmacy Provider Manual
- Review and comply with HIPAA, Medicare, Medicaid and other federal and state regulations relating to pharmacy contracting
- Assist with audit resolution processes. Analyze affected agreements based on audits by CMS, health plans and their employer groups and organize and document facts to respond to audits
- Support Prime’s pharmacy termination process, including pharmacy appeals and debarment
- Support Network Management projects and provide back-up as needed
- Other duties as assigned
- Bachelors degree or equivalent work experience
- 2 or more years of provider relations or healthcare experience working with contracts
- Proficient with MS Word, Excel, and Access
- Experience with Contract Management software
- Experience with working with a large volume of contracts
- Experience drafting contracting language
- PBM experience
- Experience maintaining and managing databases
- Proven ability to work independently and collaboratively as part of an effective team
- Ability to prioritize, meet deadlines and drive tasks to completion
- Advanced written and verbal communication skills
- Strong attention to detail
- Capable of handling multiple projects simultaneously and working well under pressure
Prime's fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in the health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.
If you are looking to advance your career within a growing and team-oriented company, apply to Prime today and start making a difference.
We are proud to be an EOE/AA employer. We maintain a drug-free and tobacco-free workplace and perform pre-employment substance abuse testing.
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