Provider Relations Specialist

Location

Hybrid (Local to NYC or Denver Metropolitan areas)

The Provider Relations Specialist provides essential credentialing review and management to support the Capital Rx networks of pharmacies. This work involves deciding whether pharmacies meeting Capital Rx’s credentialing requirements allowing for inclusion in the Capital Rx pharmacy networks and maintaining the information related to credentialing. The ideal candidate will have experience in credentialing providers, managing reporting requests, and contribute to scalable solutions to streamline processes.

• Manage the standard credentialing review process for applicable pharmacies for inclusion in the provider networks andmaintainthe information related to credentialing so that Capital Rx 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 Capital Rx.
• Manage,reviewand decide whether the applicable pharmacies are valid by reviewing exclusion lists on an ongoing basis toidentifyany 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 all relevant credentialing information.
• Manage credentialing reporting requests.
• Gather and track annual pharmacy required attestations.
• Manage and review development andimplementof credentialing policies and procedures.
• Gather pertinent information from pharmaciesregardingservices offered and opportunities and provide direct contracting support to Provider Relations leadership as needed.
• Provide otherassistanceas assigned to the Provider Relations team.

• 2+ yrs. of experience in healthcare, pharmacy credentialing, contracting, provider relations, pharmacy, accountmanagementor 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 provide persistent outreach to pharmacy providers to close out contracts and tasks.
• Ability to work independently, track work/projects appropriately and remain on task.
• Strong communication skills with the ability to develop effective working relationships with providers and internal and external stakeholders.
• Intermediate level ofproficiencywith Microsoft Excel, Word, PowerPoint.

• PBM and pharmacy technician experience preferred

$50,000 - $60,000 USD

All employees are responsible for adherence to the Capital Rx 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.

Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, 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.

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