Payor Compliance & Credentialing Specialist

RXinsider LTD.; Arizona; On-site; USD 65,000 - 100,000; Full time

Benefits offered by this job

Health, dental, vision insurance

401k with matching

Relocation assistance

Job summary

Boesen & Snow Law is seeking an experienced Payor Compliance & Credentialing Specialist in Scottsdale to own a broad portfolio of PBM/payor credentialing, regulatory audits, and pharmacy operations compliance. You will guide credentialing from initial application through renewal and support audit responses with precision.

You will work directly with attorneys and pharmacists, ensuring accurate submissions and timely communications across multi-state payor requirements.

Qualifications

• 3+ years of experience in pharmacy licensing, payor credentialing, or healthcare regulatory compliance.
• Active CPhT certification (any U.S. state) preferred; equivalent experience considered.
• Proficient in Microsoft Office (Outlook, Word, Excel).
• Strong written and verbal communication skills.

Responsibilities

• Prepare and submit Federal/State payor credentialing applications, including gathering required documentation and ensuring submissions are complete and accurate.
• Manage PBM network enrollment and contracting applications for pharmacy clients to ensure patient claim submission capability upon approval.
• Serve as primary contact with PBMs/Payors, managing correspondence and navigating state-specific and contractual requirements.
• Build and maintain robust tracking systems for deadlines, statuses, and documentation; flag risks early.
• Produce clear status reports for attorneys and clients throughout credentialing or audit lifecycle.
• Support attorneys and clients during PBM/Payor audits and regulatory audits with documentation and correspondence.

Skills

Payor credentialing

Regulatory compliance

Attention to detail

Multitasking

Communication

Project management

Education

Associate's or Bachelor's degree in a health-related field

CPhT certification (preferred)

Tools

Microsoft Office

Job description

Boesen & Snow Law is a nationally recognized healthcare and pharmacy law firm headquartered in Scottsdale, Arizona, with an additional office in Indianapolis, Indiana. We focus exclusively on health and pharmacy law, representing a sophisticated client base that spans individual healthcare providers, multi-state pharmacy operators, and corporate entities across the full spectrum of healthcare delivery. This includes 503A compounding pharmacies, 503B outsourcing facilities, retail, specialty, and mail-order pharmacy operations.

Our team of 11 attorneys, three licensed pharmacists, and 15 professional staff members brings a rare combination of legal expertise and hands‑on industry knowledge to every client engagement. We advise clients on FDA and DEA regulatory compliance, pharmacy licensing and operations, professional license defense, and complex healthcare transactions. We handle matters where the stakes are high and precision is everything.

The Opportunity

We are seeking an experienced Payor Compliance & Credentialing Specialist to join our Scottsdale team and take ownership of a broad and complex portfolio spanning PBM/Payor credentialing PBM/Regulatory Audit defense, and Pharmacy Operations Compliance. This is not an entry‑level position. We are looking for a specialist who understands the regulatory/contractual landscape governing pharmacy audit, brings hands‑on experience with payor credentialing processes, and can manage high‑volume, concurrent engagements with minimal oversight.

You will work directly alongside attorneys and pharmacist consultants, serving as the operational backbone for client engagements—guiding a credentialing matter from the initial payor application through final approval and ongoing renewal, or managing an audit response from the first discrepancy review through appeal and final resolution. Your work has direct implications for our clients' ability to operate and maintain compliance with their payor contracts. Accuracy, accountability, and follow‑through are non‑negotiable.

Reports to:

Director of Payor Compliance & Credentialing

What You'll Own

• Prepare and submit Federal/State payor credentialing applications, including gathering required documentation, interpreting application requirements, and ensuring submissions are complete and accurate


• Manage PBM network enrollment and contracting applications for pharmacy clients, including major benefit managers such as CVS Caremark, to ensure patient claim submission capability upon approval


• Serve as the primary point of contact with PBMs/Payors, managing correspondence, responding to deficiencies, and navigating state‑specific and contractual requirements with confidence


• Build and maintain robust tracking systems for deadlines, application statuses, recredentialing, and required documentation, proactively flagging risks before they become problems


• Produce clear, accurate status reports for attorneys and clients throughout the credentialing or audit lifecycle


• Support attorneys and clients during PBM/Payor audits and regulatory audits, including preparation and review of required documentation and correspondence

Qualifications

• Associate's or Bachelor's degree in a health‑related field, business, or equivalent experience preferred


• 3+ years of experience in pharmacy licensing, payor credentialing, or healthcare regulatory compliance


• Active CPhT certification (any U.S. state) preferred; equivalent experience considered


• Proficient in Microsoft Office (Outlook, Word, Excel)


• Strong written and verbal communication skills

What You Bring

• Experience with PBM network enrollment and pharmacy benefit structures, including familiarity with major payor portals such as CVS Caremark, Express Scripts, and OptumRx


• Familiarity with federal enrollment and registration processes, including Medicare/Medicaid enrollment (CMS-855, PECOS) and DEA registration and renewals


• Experience with payor credentialing, regulatory agency audits, or pharmacy compliance processes; familiarity with audit documentation, inspection preparation, and regulatory correspondence strongly preferred


• Working knowledge of pharmacy operational workflows, including dispensing processes, inventory management, and day‑to‑day pharmacy operations


• Experience reviewing and managing prescription documentation, including signature logs, copay collections, and related pharmacy audit response records


• Proven ability to manage multiple concurrent project deadlines independently in a high‑volume, deadline‑driven environment


• Exceptional organizational skills and documentation discipline and you build reliable tracking systems and maintain them consistently under pressure


• Ability to multitask and shift priorities fluidly in a fast‑paced, client‑facing environment without sacrificing accuracy or attention to detail


• Strong analytical and problem‑solving skills, you anticipate next steps, identify gaps before they become issues, and follow through without being prompted


• Demonstrated experience managing pharmacy or healthcare entity payor credentialing at a multi‑state or national scale; law firm, consulting, or pharmacy operations background strongly preferred

Compensation

$65,000 – $100,000, depending on experience

Benefits & Schedule

Full‑time, 40 hours per week, on‑site in Scottsdale, AZ. Some work outside regular business hours may be required.

Benefits include health, dental, vision insurance, paid time off, 401k with 4% matching, and relocation assistance for qualified candidates.