Sr. Pharmacy Network Representative

ESSENTIAL DUTIES AND RESPONSIBLITIESinclude but are not limited to the following:

â Responsible for day-to-day operational support for pharmacy questions via phone and/or email.

â Responsible for Network Development emails; respond to requests and questions from pharmacies in a timely

manner.

â Initiate and tracks contract from initial draft to full execution.

â Provide written and/or verbal contractual education for pharmacies as needed.

â Target and recruit additional pharmacies to meet Plan network adequacy requirements and/or requests and

maintain network relationships with small independent/chain pharmacies.

â Participate in re-contracting efforts as required and directed.

â Shepherd contracts through the negotiation process for independent pharmacies and small chains and maintain

relationships with those contracted entities.

â Lead Hospice Contracting initiatives.

â Update multiple systems with contract data and demographic information as required.

â Submit pricing changes to the Quality Assurance team.

â Assist in RFP responses.

â Responsible for maintaining the Pharmacy Administrative Manual (PAM).

â Work with the Credentialing Specialist to ensure credentialing standards are met.

â Investigate pharmacy claim issues; pricing complaints and perform Pricing Escalation triage for the network

Analyst.

â Communicate with the MAC/Reimbursement team as required.

â Participate in the weekly GER review call and make changes in the system based on those reviews.

â Attend meetings for new plan implementations.

â Ensure deliverables are on time and meet quality levels as expected by ProCares internal and external customers.

â Coordinate and follow up on pharmacy network fax/email blasts as required.

â Responsible for oversight of monthly import reports and weekly cascading of data through various systems.

â Prepare documentation for audits as requested by manager and support URAC accreditation.

QUALIFICATIONS AND REQUIREMENTS

â Must be a strong team player who can adapt to a team environment and work independently in a fast-paced

environment.

â Must be able to work in multiple computer systems simultaneously on a daily basis.

â Excellent telephone etiquette and verbal/written communication skills.

â Must be highly organized motivated take initiative and possess a willingness to learn new processes.

â Extreme attention to detail required.

â Working knowledge of computers and related software applications such as Word Excel Adobe and Outlook a

must.

â Must be able to review contracts and learn the differences of each contract.

EDUCATION AND EXPERIENCE

Associates Degree with two years of experience in a health care setting working with contracts and/or provider

relations preferred. PBM experience a plus.

PHYSICAN DEMANDS

Requires sitting standing and occasional light lifting.

Please notewhile this job description is a comprehensive overview additional responsibilities may be part of the role.

ProCare Rx will never ask for a financial commitment from an applicant as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries please email us at

ProCare Rx is an Equal Opportunity Employer.

Required Experience:

Senior IC