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Job Posting Title

Sr Resolution Specialist

Job Description

The Resolution Specialist Sr is responsible for owning the Pharmacy contract termination processes. This position will be the key point of contact and operator for terminations originating from external network vendor and Prime Therapeutics based networks. The role will be accountable for developing and maintaining the termination processes and analyzing for member and network disruption.

Responsibilities

• Own end to end Pharmacy termination process for both Prime and the external network vendor network; serve as main point of contact for internal and external stakeholders, manage intake and system documentation for pharmacy termination process

• Create, edit and send termination communication to plans, pharmacies and/or PSAOs (Pharmacy Services Administrative Organization) including termination intent and contract termination; partner with Member Materials, Client Engagement and Contact Center for termination communication to members

• Partner with key internal stakeholders to initiate pharmacy terminations and maintain appeal guidelines to support Credentialing Committee and PDAC termination reviews; provide support to Prime’s Credentialing Committee and PDAC (Prime Disciplinary Action Committee) regarding terminations; research pharmacy contract status and review network capabilities and impacts to applicable parties

• Analyze data to determine network and member disruption resulting from pharmacy termination and identify member access issues to inform termination communication strategies to internal and external stakeholders

• Respond to requests for documentation related to litigation, subpoenas, or any other third-party requests for information; coordinate external meetings, documentation review and status reporting with pharmacy’s legal counsel as required; support internal litigation management efforts and maintain appropriate tracking information regarding potential pharmacy terminations and termination appeals; receive and prepare audit documentation supporting pharmacy termination appeals

• Independently identify, resolve, and/or escalate current or potential client and member issues with external network vendor, internal stakeholders and network leadership

• Other duties as assigned

Minimum Qualifications

• Paralegal Certificate and/or Associates degree in Paralegal Studies or related field of study, or equivalent combination of education and/or relevant work experience; HS diploma from an accredited school or GED required

• 4 years of experience within Legal or Compliance related role

• Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

• Strong interpersonal, verbal and written communication skills

• Ability to manage multiple priorities and maintain appropriate prioritization and productivity while working under deadlines

• Ability to analyze, synthesize and manage complex information

• Proven problem solving and critical thinking skills

• Experience with Excel, PowerPoint, Word, Access

Preferred Qualifications

• Bachelors degree in Legal Studies or related field of study

• Employment as a Legal Assistant/Paralegal for PBM or healthcare company or law firm advising a healthcare company

• Familiarity with contract terms and a thorough understanding of the contract negotiation process

• Familiarity with Medicare Part D and Medicaid

Minimum Physical Job Requirements

• Constantly required to sit, use hands to handle or feel, talk and hear

• Frequently required to reach with hands and arms

• Occasionally required to stand, walk and stoop, kneel, and crouch

• Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds

• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Reporting Structure

• Reports to Director in Network Management

Potential pay for this position ranges from $74,500.00 - $111,700.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/benefits) and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.

Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.