Pharmacy Network Administrator - Remote in the California market

$43,181 - $64,771/Yr

Prime Therapeutics - Raleigh, NC

Full-time - Entry Level

Remote - Raleigh, NC

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, identifying barriers to credentialing and contracting requirements, and facilitating solutions. The administrator acts as a liaison between internal and external stakeholders, ensuring effective communication and problem resolution related to pharmacy network enrollment and payment processes.

Responsibilities

• Manage credentialing and contracting projects, coordinating with third-party vendors and provider communications.
• Create, design, test, and implement production and audit reports.
• Set up and support pharmacy payment center operations and contract rollouts.
• Serve as a liaison to field staff for geographic locations, resolving provider issues and complaints.
• Coordinate state Fee For Service client's pharmacy network enrollment as assigned.
• Handle 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 work performance of others.
• Intermediate MS Excel skills and 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
• Paid holidays
• Paid time off (PTO)
• Flexible scheduling
• Professional development opportunities
• Employee discount programs