Affiliation Specialist

Job Title: Affiliation Specialist

Reports to: Supervisor, Affiliation

Location: Remote

FLSA Status: Non-Exempt

Job Summary

This position is responsible for the verification of pharmacy affiliation status, including the implementation and verification of 835 file onboarding process, PSAO contract affiliation, standalone service adds, assisting pharmacies with direct contract affiliation, and processing immediate and 30-day termination notices. This person works closely with the Credentialing and Pharmacy Services teams to ensure timely and accurate affiliation of new pharmacy enrollments to PBM agreements. He/she is primarily responsible for processing necessary enrollment paperwork to obtain 835 files and to support central pay and non-central pay functions. The team works closely with EDI to verify 835 files are connected appropriately.

Essential Job Functions

  • Identify and maintain affiliation enrollment procedures to ensure timely and accurate pharmacy affiliation to PBM contracts, central pay 835 files, and standalone service adds.
  • Manage non-central pay 835 file affiliation process to ensure timely and accurate set-up and receipt of 835 files.
  • Work with the Reconciliation team to ensure 835 files are received in the initial set-up process in a timely manner and to resolve gaps in affiliation.
  • Work with management to maintain policies and procedures to ensure successful onboarding of new pharmacies to AlignRx PBM agreements and non-central pay 835 file processes.
  • Document call and work activity in the Pharmacy Data Management System (PDMS) and review the daily notes report to ensure follow-up and resolution.
  • Monitor and address issues from the Affiliation Support inbox.
  • Act as liaison between pharmacy and PBM contacts regarding direct contracts and the affiliation process.
  • Process service- and PSAO-level terminations.
  • Actively participate in Affiliation team meetings.
  • Abide by department workflow, policies, and procedures.
  • Remain current on pharmacy industry trends and be aware of AlignRx pharmacy member business needs and concerns.
  • Follow defined work plans and leadership direction to meet due dates when addressing pharmacy member concerns or adverse issues.

Minimum Qualifications

  • Three years of administrative/clerical/customer support experience and relevant pharmacy PBM-related experience.
  • Ability to effectively follow oral/written instructions, analyze data, apply good fact-finding skills to solve relevant and related pharmacy problems associated with services provided to clients.
  • Excellent written and verbal communication skills.
  • Experienced in MS Word and Excel.
  • Detail-oriented team play who is able to manage multiple priorities and projects.

Additional Responsibilities

  • Perform other duties and projects as required by management.
  • Process and submit monthly and quarterly rosters for various PBM contracts for affiliation and terminations.
  • Respond to customer inquiries throughout affiliation process via email and phone.
  • Map and maintain PBM enrollment forms in the credentialing system.

Knowledge, Skills & Abilities

  • Good verbal and written communication skills.
  • Good interpersonal skills; able to work well with a wide range of people.
  • Strong organizational and time-management skills.
  • Demonstrate dependability through good attendance and adherence to timelines and schedules.
  • Good follow through on projects and deliverables.
  • Good analytical skills and problem-solving skills.
  • Demonstrate resourcefulness and an ability to take initiative in the development and completion of projects.
  • Strong sense of customer service.
  • Demonstrate basic computer knowledge through effective use of a personal computer, including Microsoft Office applications. Computer skills to include: file management skills, Internet, Microsoft Windows, database, word processing (Word), spreadsheets (Excel), presentation software (PowerPoint), and graphics.

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.

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.

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Affiliation Specialist