Pharmacy Network Coordinator

This is a fully remote position, open to applicants in Florida.

📋 Description

• Responsible for maintaining and auditing pharmacy network directories, contracts, and credentialing records to ensure accuracy and compliance.

• Acquires necessary licenses and certificates of insurance from pharmacies.

• Confirms eligibility using the NCPDP database and federal and state resources, including OIG, GSA, and SAM.

• Manages onboarding, terminations, and status modifications for retail, mail-order, and specialty pharmacies.

• Acts as the primary point of contact for network pharmacies on a daily basis, addressing claims, enrollment, and access concerns.

• Collaborates with claims and clinical teams to resolve pharmacy-level adjudication and payment problems.

• Assists the benefit and navigation team with issues related to the network.

• Creates and presents ad hoc network reports for clients.

• Contributes to documenting and enhancing network operations processes consistently.

⛳️ Requirements

• Over 2 years of experience in pharmacy benefits, PBM operations, network management, or a related healthcare position.

• Solid understanding of pharmacy network contracting, credentialing, or claims adjudication.

• Capable of working independently with a keen attention to detail and adeptness in managing data across various systems.

• Exceptional written and verbal communication skills, demonstrating a service-first attitude towards pharmacy partners.

• Demonstrated success in high-pressure environments, managing multiple priorities concurrently while displaying the initiative and determination necessary to engage pharmacy providers and complete contracts and tasks.

• Intermediate proficiency in Word, Excel, or Google Sheets; experience with PBM or claims platforms is advantageous.

• Knowledge of PBM regulatory standards and network adequacy requirements.

• Experience working directly with retail, mail-order, or specialty pharmacies.

• PTCB certification (or state license) is required.

🏝️ Benefits

• Bonus

• Equity