Easter Seals Jobs

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Job Posting Title

Maximum Allowable Cost Programs Specialist - Remote

Job Description Summary

The purpose of this position is to ensure that staff assigned to specific accounts meet requirements set by customer. Responsible for coordination and monitoring of the administrative provisions of the Prime Therapeutics contracts with providers. This is to include providing assistance with the delivery and of coordination of MAC (Manager Administration Contract) services and systems in accordance with contract specifications. The position coordinates and provides educational assistance to network providers regarding pharmacy reimbursement, provides liaison services between enrolled providers and the Medicaid departments, and supports providers during the enhancement of the program. Staff members serving in this position serve as experts on MAC provider reimbursement issues for their respective assigned accounts.

Job Description

• Assesses provider appeals inquiries, researches various pricing resources and makes appropriate recommendations using organization databases and applications.

• Responsibilities include responding to provider appeals accurately and timely according to the client's specific requirements based on current market conditions and discovering and monitoring trends that that occur.

• Continuous quality assurance review of products with established MAC prices to ensure a given product is ultimately eligible for a MAC price and to determine if there is drug availability or shortage issues.

• Serves as Prime Therapeutics expert in effectively communicating with providers about policies and procedures and other issues.

• Activities include working with appropriate staff to clarify and recommend changes to policies, procedures and pricing logic which have an impact on management and outcomes of the MAC program.

• Provides issue resolution and complex trouble shooting skills to providers, acting as the liaison between various Medicaid departments and the provider community, with the goal being to reach satisfactory results with a minimum level of direct intervention from the Corporate level.

• Coordinates, assists with implementation, and monitors development of changing or expanding MAC services by working with Medicaid staff and individual providers.

• Develops and evaluates provider educational materials. Responsibilities include design and development of newsletters and tutorials that will assist in further educating providers when changes are implemented.

• Serves as subject matter expert and assists internal efforts to educate internal staff to product as well as providing RFP support as necessary.

Responsibilities

• Strong verbal and written communication skills.

• Strong working knowledge of Microsoft Office Suite, specifically Excel.

• 3-5 years of experience in pharmacy arena.

• Knowledge of public sector.

Work Experience

Work Experience - Required:

PBM (Pharmacy Benefit Management)

Work Experience - Preferred:

Education

Education - Required:

Bachelors

Education - Preferred:

Certifications

Certifications - Required:

Certifications - Preferred:

Potential pay for this position ranges from $47,500.00 - $71,240.00 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/careers/benefits/) and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is an Equal Opportunity Employer and a Tobacco-free workplace . We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures .

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 an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. ​ 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.