Prime Therapeutics LLC (Prime) is an innovative and emerging leader in the pharmacy benefit management (PBM) industry. Our mission is to provide the highest quality care and service for our members and empower clients to make informed decisions in health care management. Our strategy is to integrate pharmacy and health management for clinical, financial and ultimately member gain. We proudly serve over 12.5 million members across the United States.If you are looking to make a difference in the lives of others, along with opportunities to develop and advance your career, come join our rapidly growing and dynamic company. We are headquartered in Eagan, Minnesota with locations in Nebraska, New Mexico, Texas and Illinois. I. Job Summary: The primary responsibility of this position is the translation of pharmacy contracts into RxClaim price files. Responsibilities also include researching, interpreting, and testing the pricing provisions of pharmacy network contracts and new products to determine the proper network, pricing design and system requirements to assure correct claims processing. II. Accountabilities: 1.Evaluate all pharmacy network contracts, develop and code pricing within the RxClaim system for new or revised pharmacy network contracts. Forward any new pharmacy pricing schedules to the Quality Assurance staff for testing to ensure that networks and pricing are coded for correct claim payment information. 2.Maintain all appropriate documentation and quality controls for maintaining accurate network lists and pricing components in RxClaims. 3.Test and implement client requested network changes for Commercial, Medicare Part D and Specialty Pharmacy Programs. Research and respond to internal referrals regarding pricing schedule or network set-up. 4.Research and respond to internal and external referrals and inquiries regarding pharmacy network pricing or claims processing. Ensure timely response to inquiries. 5.Participate in the Prime internal RxClaim User Group and perform testing of system releases that relate to pharmacy networks and pricing. Identify and document system problems. Escalate system defects with a sense of urgency to avoid pharmacy or member disruption. 6.Utilize the SPSS Showcase query tool to assist with quality assurance of network and pricing set-up from project preparation to project completion. 7.Provide quality review of pricing/network changes and executed Pharmacy Network Agreements performed by peers to assure all appropriate information has been received and that system data supports contractual requirements. 8.Work with Benefit Design and Network Management to identify communication processes and incorporate work flows between benefit designs and pricing schedules to assure updates are applied when new clients are implemented and new pharmacy rates become effective. 9.Participate in Pharmacy Network Management projects and provide back-up assistance as needed.III. Job Requirements: 1.Bachelor’s degree preferred or 3-5 years relevant experience. Pharmacy Technician Certification preferred. 2.Extensive knowledge of Pharmacy or Medical claims processing. 3.AS400 system experience preferred. 4.Strong written and oral communication skills. 5.Strong organizational and analytical skills with the ability to be attentive to detail. 6.Flexibility in job duties, with the ability to work on multiple projects simultaneously. 7.Advanced knowledge of Microsoft Word and Excel applications. 8.Some non-standard hours and travel are required.WHY WORK FOR PRIME?oPrime is a Growing Company oOpportunities for Training and Career Advancement oCompetitive Pay and Benefits: Prime offers a competitive salary with bonus incentives. In addition, Prime provides an excellent benefit package including: medical, dental, vision, company paid life insurance, company paid disability insurance, generous Paid Time Off, 401(k) with a two component match, tuition reimbursement and more. oGreat Work Environment: Our work facilities are modern, clean and provide our employees with the most up-to-date technology. We have a high-energy, fast-paced culture where we value new ideas, build teamwork and celebrate our accomplishments. We are proud to be an EEO/AA employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse testing.