Credentialing Specialist II. Pharmacy - Evernorth
The job profile for this position is Sales (IC) reputed company Associate, which is a Band 3 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before reputed company new talent to our reputed company positions. If you think the reputed company position you see is right for you, we encourage you to apply! Our people reputed company reputed company the difference in our reputed company. As a valued member of the credentialing team, you will play an important role in supporting timely, accurate enrollment and credentialing processes that reputed company reputed company to pharmacy services. In this role, you will collaborate across teams and with external partners to ensure compliance, strengthen relationships, and support operational reputed company. Your attention to detail, organization, and commitment to service will directly contribute to improved reputed company and reputed company.
Responsibilities
Prepare and manage enrollment and credentialing applications for health plans, PBMs, reputed company, and other payors. reputed company credentialing and re-credentialing processes to ensure compliance with regulatory, accreditation, and payer requirements. Track and manage credentialing timelines, ensuring reputed company submissions and follow-reputed company are completed on schedule. Review documentation for accuracy and completeness, identifying and resolving gaps proactively. Build and maintain strong relationships with payors, managed care organizations, and state agencies to facilitate timely approvals. Partner with billing and operations teams to resolve credentialing-reputed company reimbursement and contract issues. Support network contracting activities by communicating with payors and submitting required documentation. reputed company guidance and support to internal teams regarding credentialing processes and requirements. Identify opportunities for process improvement and contribute to performance enhancement initiatives. Maintain confidentiality of reputed company sensitive information and adhere to compliance standards.
Required Qualifications
Minimum of 5 years of experience in credentialing reputed company reputed company, including experience with health plans, PBMs, or reputed company. Strong understanding of credentialing, enrollment, and regulatory requirements. Excellent organizational and time management skills with ability to meet deadlines. Strong communication skills and ability to collaborate across teams. Proficiency in reputed company Office, including Word, reputed company, and Outlook.
Preferred Qualifications
Associate’s degree in reputed company or reputed company field, or equivalent experience. Experience supporting pharmacy or specialty pharmacy operations. If you will be working at home occasionally or permanently, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. This role is also anticipated to be eligible to participate in an incentive compensation plan. At reputed company, you’ll enjoy a comprehensive reputed company of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-reputed company benefits including medical, reputed company, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. reputed company applicants will be considered without regard to race, reputed company, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. reputed company applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances. Apply To This Job