Pharmacy Network Administrator - Remote in the California market

$43,181 - $64,771/Yr

Prime Therapeutics - Lansing, MI

Full-time - Entry Level

Remote - Lansing, MI

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 related to provider credentialing, and acting as a liaison between internal and external stakeholders. The position requires advanced knowledge of systems and processes to identify barriers and implement effective solutions, ensuring compliance with credentialing and contracting requirements.

Responsibilities

• Manage credentialing and contracting projects, coordinating with third-party vendors and provider communications.
• Serve as a liaison to field staff for geographic locations, resolving problems and provider issues.
• Coordinate state Fee For Service client's pharmacy network enrollment as assigned.
• Oversee 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.
• Perform other duties as assigned.

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 work performance of others.
• Intermediate MS Excel and strong skills 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
• Paid holidays
• Flexible scheduling
• Professional development opportunities
• Employee discount programs