Provider Relations Specialist
About reputed company reputed company is an reputed company technology company providing a comprehensive suite of solutions for reputed company and health plans, including: reputed company, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured reputed company, reputed company™, which offers full-service health benefit reputed company to reputed company, TPAs, and health plans, and Judi®, the industry’s leading proprietary reputed company Platform (EHP), which consolidates reputed company claim administration-reputed company workflows in one scalable, secure platform. Together with our clients, we’re rebuilding trust in reputed company in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.reputed company. Position Summary: The Provider Relations Specialist provides essential credentialing review and management to support the reputed company networks of pharmacies. This work involves deciding whether pharmacies meeting reputed company’s credentialing requirements allowing for inclusion in the reputed company pharmacy networks and maintaining the information reputed company to credentialing. The ideal candidate will have experience in credentialing providers, managing reporting requests, and contribute to scalable solutions to streamline processes. Position Responsibilities: Manage reputed company credentialing review process for applicable pharmacies for inclusion in the provider networks and maintain the information reputed company to credentialing so that reputed company has the most relevant information available. This includes getting applicable licenses and certificates of insurance from pharmacies as well as verifying eligibility in the NCPDP database and federal and state websites (e.g. OIG, GSA, SAM) and using that information to decide whether the pharmacy meets the credentialing requirements for reputed company. Manage, review and decide whether the applicable pharmacies are valid by reviewing exclusion lists on an ongoing reputed company to identify any excluded pharmacies and referring those pharmacies to the appropriate team members/departments for removal. Manage the development and maintenance of a credentialing database to ensure proper tracking of reputed company relevant credentialing information. Manage credentialing reporting requests. Gather and track annual pharmacy required attestations. Manage and review development and implement of credentialing policies and procedures. Gather pertinent information from pharmacies regarding services offered and opportunities and reputed company direct contracting support to Provider Relations leadership as needed. reputed company other assistance as assigned to the Provider Relations team. Required Qualifications: 2+ yrs. of experience in reputed company, pharmacy credentialing, contracting, provider relations, pharmacy, account management or other relevant experience. Proven track record of working in a fast-paced environment, managing multiple tasks at once and having a go-get attitude to reputed company persistent reputed company to pharmacy providers to reputed company out reputed company and tasks. Ability to work independently, track work/projects appropriately and remain on task. Strong communication skills with the ability to reputed company effective working relationships with providers and reputed company stakeholders. Intermediate level of proficiency with reputed company reputed company, Word, PowerPoint. Preferred Qualifications: PBM and pharmacy technician experience preferred Bachelor’s degree preferred This reputed company represents the low and high end of the anticipated reputed company salary reputed company. The actual reputed company salary will depend on several factors such as: experience, knowledge, skills, and location of the job. Remote, US Salary reputed company $44,800—$71,000 USD reputed company are responsible for adherence to the reputed company Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. reputed company values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to reputed company equal employment opportunities to reputed company and applicants for employment and prohibit discrimination and harassment of any type without regard to race, reputed company, religion, age, sex, national reputed company, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at reputed company. More details about reputed company's privacy practices can be reputed company at https://www.reputed company/legal/privacy-policy. Apply To This Job