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Credentialing Specialist
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Job Description
- Req#: 42791
Employer Industry: Specialty Pharmacy Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Engaging work culture recognized as a Great Place to Work®
- Comprehensive benefits, perks, and wellness programs offered
- Supportive and collaborative environment focused on diversity, equity, inclusion, and belonging
- Chance to lead credentialing processes in a critical healthcare sector
What to Expect (Job Responsibilities):
- Lead the end-to-end credentialing and re-credentialing processes for specialty pharmacies
- Prepare, track, and manage credentialing submissions for major pharmacy benefit managers (PBMs) and health plans
- Ensure compliance with 340B program requirements and maintain active provider status
- Collaborate with various departments to support payer network participation
- Develop and maintain a centralized credentialing database with real-time updates
What is Required (Qualifications):
- Bachelor's degree or equivalent combination of education and experience
- Minimum of 5 years' experience in healthcare credentialing, with at least 2 years related to PBMs and health plans
- Familiarity with CAQH ProView, NPPES, PECOS, and Medicare/Medicaid enrollment portals
- Working knowledge of specialty pharmacy operations and payer network participation
- Excellent organizational, time management, and problem-solving skills
How to Stand Out (Preferred Qualifications):
- Experience supporting specialty pharmacy services for oncology, immunology, or rare diseases
- Knowledge of IRA (Inflation Reduction Act) implications on Medicare-related credentialing
- Certified provider credentialing specialist (CPCS) certification
#SpecialtyPharmacy #HealthcareCareers #Credentialing #CareerGrowth #DiversityInclusion
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