Credentialing & Medicaid Specialist - Specialty Pharmacy

Location: The Bronx

Credentialing & Medicaid Specialist - Specialty Pharmacy

Salary: $65,000-$72,000 (flexible based on experience)
Location: Fully Remote (Working EST hours)

Summary
Our client, a growing specialty pharmacy organization with bi-coastal operations and nationwide licensure, is seeking a Credentialing & Medicaid Specialist to support ongoing payer participation and enrollment activities. This role plays a critical part in maintaining active status with Medicaid programs and payer networks, ensuring seamless operations across multiple sites.
This is a stable, well-functioning environment where the right individual can take full ownership of the credentialing function while positioning themselves for long-term growth.

What You'll Do

• Own and manage all Medicaid provider enrollments and revalidations across multiple states

• Prepare and submit enrollment applications, provider updates, and required documentation to Medicaid agencies, PBMs, and health plans

• Maintain accurate and up-to-date credentialing records, including licenses, accreditations, and compliance documentation

• Monitor payer and Medicaid communications, identifying and executing on required actions

• Track credentialing expirations and ensure timely renewals to prevent lapses in participation

• Maintain contract and credentialing repositories, ensuring documentation is organized and accessible

• Partner closely with the Billing team to resolve enrollment issues impacting claims

• Route and manage provider and payer communications internally across Compliance, Operations, and Leadership

• Support contract administration activities, including tracking agreements and amendments

What You Bring

• 3+ years of direct experience with Medicaid enrollments and provider credentialing specifically for a specialty pharmacy or PBM

• Experience working for a specialty pharmacy or a rare disease pharmacy

• Background working with PBMs, and managed care environments

• Hands-on experience working with state Medicaid agencies and payer portals

• Strong understanding of payer structures, including Medicaid and PBMs

• Exceptional attention to detail with the ability to manage high volumes of documentation accurately

• Ability to work independently in a fully remote environment with minimal oversight

• Multi-state Medicaid enrollment experience

• Familiarity with PBM and commercial payer requirements

• Knowledge of Medicaid FFS vs. MCO structures