Credentialing & Medicaid Specialist – Specialty Pharmacy

Credentialing & Medicaid Specialist – Specialty Pharmacy

$65,000–$72,000 (flexible based on experience)

Fully Remote (Working EST hours)

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.

• 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

• 3–5+ years of direct experience with Medicaid enrollments and provider credentialing
• 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