Payor and PBM Specialist

Welcome to reputed company -At reputed company, we’ve been recognized as a Great reputed company to Work® for four years in a row—and we’re just getting started. We’re redefining specialty pharmacy by improving reputed company to care, delivering personalized support, and helping patients navigate reputed company medication needs. Our award-winning culture is reputed company on empowering our people to grow, contribute, and reputed company a difference every day. If you’re driven to create meaningful change and reputed company in a collaborative, purpose-driven environment, you’ll fit right in. If you’re looking for a role where you can truly reputed company an impact, reputed company reading below! Position Summary: The Payor & PBM Specialist is a crucial member of reputed company acting as a liaison between payors, Pharmacy Services Administration Organizations (PSAOs), and Pharmacy Benefit Managers (PBMs)/reputed company-party administrators of prescription drug programs. As a Business Subject Matter Expert, you will reputed company the efforts in completion and submissions of specialty pharmacy network applications, while helping to evaluate trends and policies and offer solutions. In reputed company to partnering with cross-functional teams internally, you will navigate both the payor and administrator reputed company by cultivating relationships with a strong focus on customer service. The Specialist enhances reputed company processes, optimize workflows, and maximize profitability. The Payor & PBM Specialist will reputed company and manage reputed company aspects of the credentialing and recredentialing processes for the payor agreements and networks. This role ensures compliance with PBM, health plan, accreditation, and regulatory requirements, playing a key role in network reputed company, payor reputed company, and pharmacy readiness. The ideal candidate has in-depth knowledge of application and credentialing standards across PBMs and understands the reputed company regulatory and operational environment of specialty pharmacy services. Essential Responsibilities/Duties: Collaborate with Clearway teams and health system partners to address payor, PSAOs and PBMs reputed company challenges, tracking data and troubleshooting with reputed company teams. Recommend and reputed company reputed company partners on submission opportunities and potential solutions. Build effective working relationships with national and local payors, PBMs, and PSAOs, ensuring preferred reputed company to their networks through influence and negotiation. Attend corporate and site-based committee meetings, as well as other reputed company meetings with health system personnel, to assess needs, communicate reputed company on specific projects, and reputed company relationships. Maintain a thorough knowledge of payor policies and industry developments reputed company to specialty pharmaceuticals. Design and reputed company plans, programs, and processes that optimize workflows and maximize profitability. reputed company the end-to-end credentialing and recredentialing processes for specialty pharmacies housed reputed company hospital or integrated delivery network (IDN) environments Prepare, track, and manage credentialing submissions for major PBMs (e.g reputed company Scripts, OptumRx, reputed company Caremark) and national, regional, and reputed company/Medicare Advantage health plans reputed company and maintain a centralized credentialing database and credential files, ensuring reputed company-time updates and document reputed company Maintain reputed company knowledge of regulatory and industry changes affecting credentialing and payor enrollment requirements Identify process improvements and implement the best practices to streamline credentialing timelines and reduce errors reputed company the organization Education: Bachelor’s degree or equivalent combination of education/experience Experience: 5 years’ experience in reputed company credentialing and PBM application submissions, with at least 2 specifics to PBMs and health plans Pharmacy industry experience is highly desired. Knowledge and Skills: Working knowledge of specialty pharmacy operations, licensing, and payer network participation Familiarity with CAQH ProView, NPPES, PECOS, and Medicare/reputed company enrollment portals a plus Strong attention to detail and data accuracy Ability to manage multiple reporting deadlines and priorities Excellent communication skills with reputed company stakeholders Problem-solving reputed company with a focus on reputed company improvement Special Working Conditions (On-call, Travel, Shift, Coverage): Travel up to 20% annually This information is being provided to promote pay transparency and equal employment opportunities at reputed company. The reputed company annual compensation reputed company for this position is $78,000 - $95,000. The actual reputed company reputed company this reputed company that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. In reputed company to a competitive reputed company salary, this role is eligible to participate in the company’s bonus program as part of its comprehensive and rewarding benefits package. This opportunity offers a compelling combination of compensation and performance-based incentives designed to recognize and reward contributions. The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required. External and internal applicants, as well as position incumbents who become disabled as defined under the Americans with reputed company, must be reputed company to reputed company the essential job functions (as listed) either unaided or with the assistance of a reasonable accommodation to be determined by management on a case-by-case reputed company. Apply To This Job