Retail Network Coordinator

POSITION SUMMARY

This position will report to the Network Manager and will assist all network areas as pharmacy contracting, network rates validations, MAC appeals, pharmacy contractual relationship, and addressing requests from pharmacies and peers. Support the department results in the performance indicators, quality controls and propose initiatives to improve processes within the areas.

ESSENTIAL ROLES AND RESPONSIBILITIES

1. Establish and maintain the relationship with PharmPix’s pharmacy network including the contracting of new pharmacies in PR and US.

1. Manage pharmacy complaints and work with the appropriate internal department for a prompt resolution.
2. Maintain an effective communication channel with the pharmacies during the process of contracting, including sending contracts, addendums and any other information required.
3. Maintain an updated list of PharmPix’s Pharmacy Retail Network (Directory) with their correct information.

1. Monitors and audit paid claims and directories for all clients, networks, reimbursement schemes, etc.
2. Support the Price Adjustment Specialist in the process of MAC Appeals when needed.
3. Revise the daily duplicate claim report and perform the necessary tasks to resolve the duplicate, including evaluation, reversal, etc.
4. Reconciliate reports including the Monthly Duplicate Report.

1. Prepare and support the Network Manager on the content, reports, and analysis required for the presentations to internal and external parties. Including but not limited to utilization, directories, paid claims reports, status reports.
2. Perform Disruption analysis for clients.
3. Validate the pharmacy relationship with Chains, PSAO and Reconciliation Center.
4. Validate the reimbursement schemes with the pharmacy and client’s contracts.

1. Run different monthly reports.
2. Support different departments in solving issues related to network.
3. Prepare for and participate in PharmPix client communications, including conference calls and on-site meetings.
4. Support all Quality Management Program initiatives.
5. Support the Network Manager in different task related to the network area.
6. Other projects and duties as assigned by the Network Manager or Operational Director.

EDUCATION

• BBA Degree in Business Administration (Required)

PROFESSIONAL EXPERIENCE

• 2 years of Clerical and/or Administrative experience preferable in a healthcare environment.

PROFESSIONAL COMPETENCIES / SKILLS

• Accurately analyze and interpret common Pharmacy Benefit terminology.
• Manage multiple priorities and work independently in a fast-paced environment.
• Must be detail oriented and highly organized.
• Ability to read and interpret documents, write reports and correspondence.
• Ability to generate reports.
• Demonstrated effective organizational and communications skills.
• Strong verbal and written communications skills
• Bilingual English and Spanish (Preferred)
• Able to effectively interact with internal departments, PharmPix clients and other healthcare professionals.
• Time Management Skills: Establishing priorities and accomplishing tasks in a timely manner
• PC skills (Microsoft System)/System oriented.
  • Excel – Advance Knowledge
  • Word – Intermediate Knowledge
• Ability to work independently and with minimal supervision, demonstrating initiative and problem-solving skills.

PHYSICAL AND MENTAL DEMANDS

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear, sitting, standing and walking
• The position requires that weight be lifted and force be exerted up to 10 pounds.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

PharmPix is an Equal Employment Opportunity Employer Minorities / Females / Disable / Veterans