Hybrid Credentialing Specialist, Provider Relations (Pharma)

Judi Health, LLC; Colorado; Hybrid; USD 52,000 - 65,000; Full time

Job summary

The Provider Relations Specialist at Judi Health, LLC provides credentialing review and management to support the Judi Rx pharmacy networks. You will determine eligibility of pharmacies, collect licenses and certificates, and verify information in the NCPDP database and federal/state sources.

This six-month engagement may convert to full-time. You will maintain credentialing databases, respond to reporting requests, and assist leadership with contracting and policy development while partnering

Qualifications

• Bachelor's degree preferred.
• 2+ yrs. of experience in healthcare, pharmacy credentialing, contracting, provider relations, pharmacy, account management or related field.
• Intermediate proficiency with Microsoft Excel, Word, and PowerPoint.
• Proven ability to manage multiple tasks in a fast-paced environment and maintain persistence in outreach to pharmacies.
• Ability to work independently and meet deadlines.
• Strong communication with internal and external stakeholders.
• PBM and pharmacy technician experience preferred.

Responsibilities

• Manage credentialing for applicable pharmacies for inclusion in the provider networks and maintain the information related to credentialing so that Judi 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).
• Ensure the applicable pharmacies are valid by reviewing exclusion lists on an ongoing basis to identify any 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 working with the appropriate internal teams.
• Manage gathering and tracking annual pharmacy required attestations to ensure compliance with contractual and accreditation requirements.
• Develop applicable credentialing policies and procedures.
• Gather pertinent information from pharmacies regarding services offered and opportunities and provide direct contracting support to Provider Relations leadership as needed.
• Provide other assistance as assigned to the Provider Relations team.

Skills

Healthcare credentialing experience

Contracting experience

Provider relations

Excel proficiency

Communication skills

Independent / self-starter

Education

Bachelor's degree preferred

Job description

The Provider Relations Specialist at Judi Health, LLC provides credentialing review and management to support the Judi Rx pharmacy networks. You will determine eligibility of pharmacies, collect licenses and certificates, and verify information in the NCPDP database and federal/state sources.

This six-month engagement may convert to full-time. You will maintain credentialing databases, respond to reporting requests, and assist leadership with contracting and policy development while partnering