Specialty Accounts Coordinator, Payer Relations bei PANTHERx Rare Pharmacy

7,000 Diseases - 500 Treatments - 1 Rare Pharmacy 

PANTHERx is the nation’s largest rare disease pharmacy, and we put the patient experience at the top of everything that we do. 

If you are looking for a career in the healthcare field that embraces authentic dedication to patient care, you don’t need to look beyond PANTHERx. In every line of service, in every position and area of expertise, PANTHERx associates are driven to provide the highest quality outcomes for our patients.  

We are seeking team members who: 

Are inspired and compassionate problem solvers;

Produce high quality work; 

Thrive in the excitement of the ever-challenging environment of modern medicine; and 

Are committed to achieving superior health outcomes for people living with rare and devastating diseases. 

At PANTHERx, we know our employees are the driving force in what we do. We cultivate talent and encourage growth within PANTHERx so that our associates can continue to explore their interests and expand their careers. Guided by our mission to provide uncompromising quality every day, we continue our strategic growth to further reach those affected by rare diseases.  

Join the PANTHERx team, and define your own RxARE future in healthcare!

Location: Pittsburgh, PA (Remote)

Classification: Exempt

Status: Full-time

Reports to: Director, Payer Relations 

Purpose

The Specialty Accounts Coordinator, Payer Relations, serves as the primary liaison between PANTHERx internal teams and payers, focusing on the resolution of claim-specific issues to ensure timely outcomes that safeguard patient access to therapy. Success in this role requires strong technical expertise in pharmacy claim processing, exceptional organizational and communication skills, proactive problem-solving, and a passion for patient advocacy to prevent therapy disruption.   This is a remote role with occasional travel required to PANTHERx headquarters or as needed in support of Payer Relations. 

Responsibilities

• Manages day-to-day claims issues within multiple payer-related queues.
• Utilizes internal adjudication systems to identify and extract key patient claim details (e.g., patient demographics, BIN, PCN, Group, ID, Rx#, drug name, PA denial info, etc.).
• Compiles patient claim information and effectively translate findings to payers via secure email.
• Prioritizes claims where patients are at risk of therapy interruption.
• Voices urgency and advocates directly with payer claim teams to expedite resolution.
• Follows up with payers based on urgency level to ensure timely decisions.
• Escalates to payer relations leadership when appropriate.
• Partners with Operations, Finance, and Revenue Cycle Management (RCM) teams to ensure payer determinations are applied correctly.
• Attends daily launch meetings with program management to review and escalate payer-related rejected claims.
• Documents all outreach and updates in internal systems to maintain visibility and continuity across teams.
• Applies strong knowledge of claims processing workflows, including DAW codes, generic substitution laws, and limited distribution drug (LDD) network access.
• Occasional travel to PANTHER headquarters or other locations as required.
• Other duties as required.

Required Qualifications

• Bachelor’s degree in Healthcare, Pharmacy, Business, or related field preferred; equivalent work experience may be considered in lieu of a degree.
• Minimum of two (2) years of experience in specialty pharmacy, pharmacy benefit management, claims processing, or related healthcare role. 
• Proven success working within pharmacy/claims management platforms.
• Strong understanding of pharmacy benefit design, prior authorization processes, and pharmacy claim processing with a proven ability to navigate complex payer systems and policies with confidence.
• Strong sense of accountability and urgency in resolving claim issues.
• Ability to translate complex issues into clear, concise requests for action
• Excellent written and verbal communication skills, with the ability to convey urgency and advocate for patients.
• Highly organized, detail-oriented, and able to manage multiple priorities in a fast-paced environment.
• Demonstrated passion for patient care and persistence in problem-solving.

Preferred Qualifications 

• Project management experience.

Work Environment

This position operates in a home or professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. 

Physical Demands

While performing the duties of this job, the employee is regularly required to sit, see, talk, or hear. The employee frequently is required to stand; walk; use hands and fingers to handle or feel; and reach with hands and arms. Visual acuity is necessary for tasks such as reading or working with various forms of data for extended periods of time. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the job.

Benefits: 

Hybrid, remote and flexible on-site work schedules are available, based on the position.  PANTHERx Rare Pharmacy also affords an excellent benefit package, including but not limited to medical, dental, vision, health savings and flexible spending accounts, 401K with employer matching, employer-paid life insurance and short/long term disability coverage, and an Employee Assistance Program!   Generous paid time off is also available to all full-time employees, as well as limited paid time off for part-time employees.  Of course we offer paid holidays too!

Equal Opportunity:

PANTHERx Rare Pharmacy is an equal opportunity employer, and does not discriminate in recruiting, hiring, promotions or any term or condition of employment based on race, age, religion, gender, ethnicity, sexual orientation, gender identity, disability, protected veteran's status, or any other characteristic protected by federal, state or local laws.