This is a fully remote position, open to applicants in Alabama, +35 more locations.

📋 Description

• Oversee the pharmacy contracting process with independent pharmacies and select chains/PSAOs, assisting management in network negotiations, including redline assessments.

• Evaluate pharmacy contract setups to guarantee adherence to pharmacy network agreements.

• Assist with pharmacy audits and initiatives aimed at network compliance.

• Conduct research and problem-solving to address claim issues and concerns.

• Manage and log requests, inquiries, and communications with network pharmacies.

• Create, review, and disseminate pharmacy communications to satisfy both internal and client needs.

• Monitor, track, and report on pharmacy compliance with applicable government regulations as well as internal policies and procedures.

• Assess and respond to independent pharmacy redlines with minimal guidance from senior leadership.

• Maintain pharmacy network operations, including designing network plans, ensuring quality assurance, and processing claims.

• Carry out additional duties as assigned.

⛳️ Requirements

• A minimum of 2 years of proven experience in a pharmacy or in direct interaction with pharmacies or accounts, preferably within the healthcare sector.

• A College degree or a 2-year Technical Degree, or equivalent experience is preferred.

• Advanced technical education is a plus.

• Certification as a Pharmacy Technician is preferred.

• 3 years of experience in a business setting.

• Experience in retail pharmacy or a managed care pharmacy environment is desirable.

• Prior experience in analyzing medical and/or pharmacy claims or credentials is highly valued.

• Proficient in Microsoft Office and industry-related software.

• Active participation in, adherence to, and support of compliance program objectives.

• Ability to consistently interact cooperatively and respectfully with colleagues.