Pharmacy Contract Support

ProCare Rx; Gainesville (GA); On-site; USD 60,000 - 85,000; Full time

Job summary

ProCareRx seeks a regulatory compliance professional to ensure state pharmacy regulations are met and changes communicated to internal and external stakeholders. You will act as SME on state requirements and support audits, corrective actions, and contract education for pharmacies.

Ideal candidates will have an associate degree with healthcare contracts experience, PBM familiarity, and strong communication skills.

Qualifications

• Associate's Degree with two years in health care setting working with contracts, regulatory compliance and/or provider relations preferred.
• PBM experience is a plus.
• Ability to interpret regulatory language and translate changes into operational requirements.

Responsibilities

• Ensure networks comply with state pharmacy regulations and communicate changes to stakeholders.
• Assist with regulatory state audits and corrective action plans.
• Provide day-to-day operational support for pharmacy questions via phone or email.
• Coordinate contract initiation to full execution and provide contractual education to pharmacies.
• Update systems with contract data and demographics; process pricing changes.

Education

Associate's Degree with two years in healthcare contracts/regulatory compliance/provider relations

Regulatory interpretation

Strong communication skills

Detail oriented

Multisystem computer use

Tools

Word

Excel

Adobe

Outlook

Job description

ESSENTIAL DUTIES AND RESPONSIBLITIES include but are not limited to the following:

• Ensure pharmacy networks comply with state-specific pharmacy regulations and communicate the 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 while assisting with the implementation of state requirements.
• 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.
• Preform 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.

• 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.

EDUCATION AND EXPERIENCE

Associate's Degree with two years of experience in a health care setting working with contracts, regulatory compliance and/or provider relations preferred.

PBM experience a plus.

PHYSICAN DEMANDS

Requires sitting, standing, and occasional light lifting.

This is a full-time position with benefits. Please visit our Contact Us/Opportunities page on our website for more information about our benefits list.

ProCareRx will never ask for a financial commitment from an applicant, as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our official recruitment team at [e-mail].

ProCareRx is an Equal Opportunity Employer.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws.

For further information, please review the Know Your Rights notice from the Department of Labor.