Job Descriptions

JOB DESCRIPTION

 

Job Title:                     Pharmacy Network Representative

Reports To:                 Director of Pharmacy Contracting

Classification:               Full Time - 40 hours per week (8:00am – 5:00pm Monday–Friday)

FLSA Status:               Non-Exempt

 

SUMMARY

The Pharmacy Network Representative will be responsible for assisting with the day-to-day operations of the Network Development department. Including, but not limited to, pharmacy outreach, contracting, data entry, pharmacy education and working internally across multiple departments. This position requires attention to detail and flexibility to meet deadlines and accommodate contracting priorities. 

ESSENTIAL DUTIES AND RESPONSIBLITIES; include, but are not limited to the following:

 

  • Provide day-to-day operational support for pharmacy questions via phone and/or email.
  • Responsible for Network Development emails; respond to requests and questions from pharmacies in a timely manner.
  • Initiates and tracks contracts from initial draft to full execution.
  • Provide written and/or verbal contractual education for pharmacies as needed.
  • Targets and recruits additional pharmacies to meet Plan network adequacy requirements and/or requests.
  • Participates in re-contracting efforts as required and directed.
  • Update multiple systems with contract data and demographic information, as required.
  • Submits pricing changes to the Quality Assurance team.  
  • Must be able to review contracts and learn the differences of each contract.
  • Work with the Credentialing Specialist to ensure credentialing standards are met.
  • Investigate simple pharmacy claim issues, help resolve pharmacy issues and complaints.
  • Communicate with the MAC/Reimbursement team as required.
  • Prepare documentation for audits, as requested by manager.
  • Attending meetings for new plan implementations.
  • Ensure deliverables are on time and meet quality levels as expected by ProCare’s internal and external customers.
  • Coordinate and follow-up on pharmacy network fax/email blasts as required. 
  • Responsible for monthly import reports and weekly cascading of data through various systems.
  • Initiates fax and email blasts to the Pharmacy Network as needed.
  • The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills or work conditions associated with the position. It is intended to be an accurate reflection of the general nature and level of the job.
 
 

 

 

 

 

QUALIFICATIONS AND REQUIREMENTS

  • Incumbent must be a strong team player who can adapt easily to a team environment or work independently in a fast paced environment.
  • Must be able to work in multiple computer systems simultaneously on a daily basis.
  • Excellent telephone etiquette and verbal/written communication skills a must.
  • Must be highly organized, motivated, take initiative and possess a willingness to learn new processes.
  • Must have excellent time management skills and able to multi-task efficiently.
  • Extreme attention to detail required.
  • Working knowledge of computers and related software applications such as; Word, Excel, Adobe and Outlook a must.
  • Working hours listed above are not negotiable.

 

 

 

 

 

 

 

EDUCATION AND EXPERIENCE

Associate’s Degree with two years of experience in a health care setting working with contracts and/or provider relations preferred.   

PBM experience a plus.

 

Physical Demands:

Requires sitting, standing, and occasional light lifting.

 

 

 

I confirm that I meet or exceed the educational and experience requirements set forth herein.

 

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Printed Name

 

 

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Signature                                                                                                               Date

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