Pharmacy Network Administrator - Remote in the California market

$43,181 - $64,771/Yr

Prime Therapeutics - Des Moines, IA

Full-time - Entry Level

Remote - Des Moines, IA

Administrative and Support Services

About the position

The Pharmacy Network Administrator serves as a key resource for credentialing and contracting projects within the pharmacy network. This role involves managing various projects, resolving issues, and facilitating communication between internal and external stakeholders to ensure compliance with credentialing and contracting requirements. The position is remote and focuses on supporting the California market.

Responsibilities

• Manage a variety of credentialing and contracting projects, including coordination with third-party vendors and provider communications.
• Create, design, test, and implement specific production and audit reports.
• Set up and support pharmacy payment center operations and contract rollouts.
• Serve as a liaison to field staff for assigned geographic locations, resolving problems and complaints.
• Coordinate state Fee For Service client's pharmacy network enrollment as assigned.
• Handle all EFT and 835 remittance enrollment and issue resolution.
• Facilitate problem resolution in areas of risk and communicate concerns from field staff and State client contacts.
• Assist in developing commercial pharmacy networks and managing network databases.

Requirements

• 1-3 years of experience in data management, credentialing, claims, insurance administration, or healthcare setting.
• Strong analysis and problem-solving skills.
• Ability to interface with multi-disciplinary high-level professionals.
• Ability to identify barriers and elevate issues effectively.
• Strong interpersonal and communication skills, both written and verbal.
• Ability to establish strong relationships and influence the work performance of others.
• Intermediate MS Excel skills and strong proficiency in other MS Office products.

Nice-to-haves

• Bachelor's degree preferred.
• Experience in Pharmacy Benefits Management (PBM), managed care, or behavioral health preferred.
• Experience utilizing quality improvement methodologies preferred.

Benefits

• Health insurance
• Dental insurance
• Vision insurance
• 401k plan with matching contributions
• Paid time off
• Flexible scheduling options
• Employee assistance programs
• Tuition reimbursement
• Professional development opportunities