Pharmacy Network Administrator - Remote in the California market

$43,181 - $64,771/Yr

Prime Therapeutics - Santa Fe, NM

Full-time - Entry Level

Remote - Santa Fe, NM

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, specifically targeting the California market, and requires strong analytical and interpersonal skills to effectively support pharmacy operations.

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, including contract rollout and special mailings.
• Act as a liaison to field staff, resolving problems, complaints, and provider issues using knowledge of credentialing and contracting information.
• 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.

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
• Paid time off
• Flexible scheduling
• Employee discounts
• Tuition reimbursement
• Professional development opportunities