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Job Description:

Credentialing Specialist needed for our client in Louisville, Kentucky for three month contract assignment.

Job description for the Credentialing Specialist needed:

Ensure each pharmacy is properly and continuously credentialed with Pharmacy PBM and Managed Care plans as designated by Senior Management. Maintain proper enrollment with National Council for Prescription Drug Programs (NCPDP) and National Plan & Provider Enumeration System (NPPES) for National Provider Identifier (NPI) enrollment. Proper enrollment as Medicare and each applicable state Medicaid provider.

Assist in completion and compilation of all documents and paperwork necessary for PBM contracting projects, specifically movement from PSAO group contracting to Direct Payer contracts.

Serve as primary resource of facility ownership, name and address information for countless purposes throughout the company. Communicate pharmacy changes/closing/openings throughout the company to maintain consistent and accurate facility information.

Maintain documented licensure for each facility with BOP, DEA and where required, State CSR licensing agency.

NCPDP enrollment and updates.

NPI enrollment and updates with NPPES.

Medicare and Medicaid enrollment and updates, including establishment of Electronic Funds Transfer (EFT) and Electronic Data Interchange (EDI) allowing claims to be submitted & R/As retrieved electronically), participation problem research and resolution as well as communication of new enrollments to Reimbursement and Operations teams.

Provide operating data (# of facilities, states operated/licensed, states of participation in Medicaid, etc.) for reporting purposes, including Quarterly & Annual Financial reports.

Execute such other functions as delegated by the Reimbursement Director or Supervisor.

All other duties as assigned.

Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.

Job requirements for the Credentialing Specialist needed:

Bachelor's degree in Accounting, Healthcare Administration, Business or Law.

At least one (1) year of pharmacy licensure experience, as well as Medicare and Medicaid enrollment experience as a healthcare provider.

3-5 years PBM or credentialing experience

Knowledge of State Boards of Pharmacy licensure requirements, Medicare and state Medicaid enrollment process. Familiarity with NCPDP & NPPES organizations and enrollment processes. Superior analytical, oral and written communication, problem solving, organizational and planning skills. Proficient in Microsoft Office software, including Excel, Outlook and Word.

Experience of legal terminology as related to the healthcare industry

Able to perform effectively, efficiently and accurately in a fast-paced dynamic corporate environment. Able to form and cultivate relationships within the company and with federal and state agency personnel to perform job to these standards. Ability to recognize and maintain confidential information related to development activities and strategic planning of the company. Ability to re-focus attention immediately and unexpectedly for problem resolution. Demonstrated ability to work effectively and congenially with employees at all levels within the organization. Strong project management skills.

Driven, energetic individual with experience of operating within the professional standards of a large pharmaceutical company.

#PCO, #Pharma

Credentialing Specialist

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Credentialing Specialist

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