Bilingual Provider Relations Representative

AlignRx is a Public Benefit LLC (PBLLC)—a for-profit limited liability company that is intended to produce a public benefit and to operate in a sustainable manner. We are the only PSAO to establish itself as this type of legal entity, as we are deeply committed to promoting the interests of community pharmacies. You can count on us to be transparent, accountable, and passionate.

As an independently owned PSAO, we want community pharmacy owners to have maximum flexibility in their buy-side choices so they can maintain control over their business. AlignRx does not require pharmacy owners to purchase from a specific wholesaler or buying group. This benefit is just one more reason that community pharmacies experience peace of mind knowing our interests are in sync with theirs.

Our mission is to support community pharmacy by offering innovative products and services that are best in class and designed to promote the pharmacies we serve as essential healthcare providers resulting in improved patient care and outcomes.

Job Summary

Within the Pharmacy Services Department, the Provider Relations Representative is responsible for providing support to pharmacy members seeking assistance or information regarding: contracted PBMs and health plans, payment rates and reimbursement status, claims processing and reconciliation, and all AlignRx programs and services. The position utilizes tools, resources, and guides to provide prompt and accurate addressing of questions and resolution of issues. The Provider Relations Representative often works closely with the PBM Account Executive and Senior PBM Account Executive on PBM and health plan issues. This role requires bilingual English and Spanish proficiency.

Essential Job Functions

• Serve as the front-line contact for AlignRx pharmacy members requesting information on, assistance with, or explanation of claims processing issues, AlignRx PSAO contracts, pharmacy not-contracted, direct contracting, claims pricing, claims reconciliation, and missing data, etc. (requests received via pharmacy member service calls, emails, or faxes).
• Maintain knowledge of existing and newly launched AlignRx programs and services, including mastering the content of AlignRx programs and services guides for the purpose of servicing pharmacy members.
• Conduct data pulls to validate contract information.
• Follow up on eRecon and Central Pay issues for pharmacy members.
• Follow defined work plans and leadership direction to meet due dates when addressing pharmacy member concerns or adverse issues.
• Abide by department workflow, policies, and procedures.
• Remain current on pharmacy industry trends and aware of AlignRx pharmacy member business needs and concerns.
• Monitor and address issues from the Customer Support email box.
• Document call and work activity in the Pharmacy Data Management System (PDMS) and review the daily Notes report to ensure follow-up and resolution.
• Attend and actively participate in Provider Relations team meetings.
• Provide support to other team members, as needed.

Additional Responsibilities

Perform other duties or projects as assigned by senior management.

Minimum Qualifications for Consideration

• Bachelor’s degree in a business-related field preferred
• Two to three years as a pharmacy technician in a retail pharmacy environment
• Fluent in English and Spanish, written and spoken

Knowledge, Skills, and Abilities

• Excellent verbal and written communication skills
• Good interpersonal skills: able to work and communicate effectively with all levels of co-workers, clients, and other external contacts
• Strong organizational and time management skills
• Dependable with good attendance and adherence to timelines and schedules
• Strong analytical skills
• Good problem-solving skills
• Consistent follow-through on issue resolution
• Resourceful, with the ability to take initiative in the development and completion of projects
• Strong sense of customer service
• Basic computer knowledge through effective use of a personal computer, including Microsoft Office applications, specifically: file management skills, Internet, Microsoft Windows, database, word processing (Word), spreadsheets (Excel), presentation software (PowerPoint), graphics
• Knowledge of and experience in the pharmacy and healthcare industry regarding terminology and retail pharmacy operations, including understanding of how and why pharmacy claims process (e.g., calculation of copayments, pricing hierarchies)
• Basic drug knowledge and understanding of Therapeutic Categories (TC), Multi-Source Indicators (MSI), Generic Product Identifier (GPI), Generic Code Number (GCN), Drug/claim statuses: Paid vs. Captured; PDL/NPDL; “F” – Formulary (paid) vs. “G” – Non-formulary paid

Physical Requirements/Working Conditions

Sedentary work, requiring the following physical activities: sitting for long periods of time; occasional bending, squatting, kneeling, stooping; good finger dexterity and feeling; frequent repetitive motions; talking, hearing, and visual acuity

Lifting of up to 20 pounds of paper supplies or minor office equipment

Conducting work in a business-type environment (e.g., desk, table) that can facilitate the use of two computer monitors

Benefits

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

NOTE: The above statements are intended to describe the general nature and level of work performed by an employee in this position. These statements are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of employees in this position.

AlignRx is an equal opportunity employer and is committed to providing a workplace free from harassment and discrimination. We celebrate unique differences of our employees, knowing diversity drives innovation, and the success of our business. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, gender identity or expression, age, marital status, veteran status, disability status, pregnancy, parental status, genetic information, political affiliation, or any other status protected by applicable laws or regulations.

Pay: $20.00 - $22.93 per hour

Application Question(s):

• Are you fluent in English and Spanish, written and spoken?

Experience:

• Pharmacy technician in retail pharmacy environment: 2 years (Required)

Work Location: Remote