Remote Pharmacy Relations Specialist II

Navitus; Atlanta (GA); Remoto; USD 65.000 - 90.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health, Dental, Vision

PTO 20 days

Parental leave 4 weeks

9 holidays

401K match up to 5%

Adoption assistance

Flexible spending account

Educational assistance & professional,

Referral bonus program

Descrizione del lavoro

Navitus Health Solutions is seeking a Pharmacy Relations Specialist to help manage contracting with independent pharmacies and select chains. The role involves ensuring network compliance, resolving claim issues, and coordinating communications with pharmacies.

The PRS II collaborates with management, audits networks, and maintains relationships to support client requests and regulatory alignment. This remote role offers comprehensive industry benefits and professional growth opportunities.

Competenze

• College or 2-year Technical Degree or equivalent experience is preferred. Advanced technical education a plus.
• Certified Pharmacy Technician preferred
• 3 years business-setting experience
• Retail pharmacy experience or experience in a managed care pharmacy setting desired
• Prior experience analyzing medical and/or pharmacy claims or credentials are highly desired
• Proficient in Microsoft Office and industry related software
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

Mansioni

• Manage pharmacy contracting process with independent pharmacies and select chains/PSAOs and assist management with network negotiations; inclusive of redline reviews
• Review pharmacy contract setup to ensure compliance with pharmacy network agreements
• Support pharmacy audits and network compliance initiatives
• Research and problem solve to resolve claim issues and concerns
• Respond to and track requests, inquiries, and communications with network pharmacies
• Develop, review, and distribute pharmacy communications to meet internal and client requests
• Monitor, track, and report pharmacy compliance with guiding government regulations and internal policies and procedures
• Reviews and responds to independent pharmacy redlines; with little to no input from senior leadership
• Responsible for all aspects of maintenance related to pharmacy network functions, such as, network plan design builds, quality assurance measures and claims processing in general
• Other duties as assigned

Conoscenze

Microsoft Office proficiency

Industry software

Communication

Team interaction

Formazione

College or 2-year Technical Degree or equivalent experience

Advanced technical education

Strumenti

Microsoft Office

Pharmacy software

Descrizione del lavoro

Navitus Health Solutions is seeking a Pharmacy Relations Specialist to help manage contracting with independent pharmacies and select chains. The role involves ensuring network compliance, resolving claim issues, and coordinating communications with pharmacies.

The PRS II collaborates with management, audits networks, and maintains relationships to support client requests and regulatory alignment. This remote role offers comprehensive industry benefits and professional growth opportunities.