Payor Credentialing & Compliance 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 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.