Pharmacy Credentialing & Enrollment Specialist (Payer Networks)

Shields Health Solutions; United States; Remote; USD 65,000 - 95,000; Full time

Job summary

Shields Health Solutions is seeking a Payor Access / Contracting Analyst to support specialty pharmacy networks remotely. You will manage multiple contracting workstreams, analyze payor and PBM requirements, and prepare applications for network access with a focus on accuracy and HIPAA compliance.

Strong Excel, PowerPoint and communication skills are essential as you collaborate with Shields partners and internal teams to drive results and improve efficiency.

Qualifications

• Experience with pharmacy claims, pharmacy benefit plans (BIN/PCN/Group), specialty medications, and specialty pharmacy clinical and operational care models
• Ability to communicate results in a clear and concise manner via Excel tables, email communication, and PowerPoint slides
• Exceptionally organized and data driven
• Comfortable and successful handling numerous concurrent work streams

Responsibilities

• Play a key role the assessment and fulfillment of clinical and operational reporting requirements mandated by payor and PBM networks
• Participate in the preparation and submission of applications related to specialty network access on behalf of Shields partners
• Conduct primary and secondary research in support of the contracting process; with a focus on payor access and specialty formularies
• Perform investigative research into pharmacy network access at the BIN/PCN/Group level; inclusive of running test claims and other data-driven methods
• Support workstreams related to state licensing matters, including new applications, credentialing, and re-credentialing
• Independently manage numerous workstreams related to contracting and payor access
• Provide exceptional and timely customer service to our partners on all matters related to contracting and payor access
• Identify solutions to non-standard requests and problems
• Willingness to do whatever is necessary for the betterment of the Company
• Protect organization's value by keeping information confidential
• Other duties as assigned

Skills

Pharmacy claims experience

Pharmacy benefit plans (BIN/PCN)

Specialty medications knowledge

Specialty pharmacy operations

Excel communication

PowerPoint skills

Data-driven

Organized

Tools

Outlook

Teams

Word

Excel

PowerPoint

Job description

Remote

Job Purpose:

The Company is seeking a highly motivated, self-starter who is looking for a challenging career with a fast-growing company in the Healthcare Services sector. Applicant should be results-oriented with a positive outlook, and a clear focus on high quality. A natural forward-planner who critically assesses own performance. Mature, credible, well-presented, professional and comfortable in dealing with others both in-person and on the phone. Critical to this position is a person who is able to work well under deadlines and time pressures. Applicant must be reliable, tolerant, and determined; an empathetic communicator, able to see things from the other person's point of view. Most importantly, person must be able to work as a member of a close-knit team.

The Payor Access / Contracting Analyst is responsible for numerous workflows involved in establishing and maintaining specialty pharmacy payor contracts on behalf of each partnering health system.

Job Duties:

• Play a key role the assessment and fulfillment of clinical and operational reporting requirements mandated by payor and PBM networks
• Participate in the preparation and submission of applications related to specialty network access on behalf of Shields partners;
• Conduct primary and secondary research in support of the contracting process; with a focus on payor access and specialty formularies
• Perform investigative research into pharmacy network access at the BIN/PCN/Group level; inclusive of running test claims and other data-driven methods
• Support workstreams related to state licensing matters, including new applications, credentialing, and re-credentialing;
• Independently manage numerous workstreams related to contracting and payor access;
• Provide exceptional and timely customer service to our partners on all matters related to contracting and payor access;
• Identify solutions to non-standard requests and problems;
• Willingness to do whatever is necessary for the betterment of the Company;
• Protect organization's value by keeping information confidential;
• Other duties as assigned;

Experience/ Education :

• Experience with pharmacy claims, pharmacy benefit plans (BIN/PCN/Group), specialty medications, and specialty pharmacy clinical and operational care models
• Ability to communicate results in a clear and concise manner via Excel tables, email communication, and PowerPoint slides
• Exceptionally organized and data driven
• Comfortable and successful handling numerous concurrent work streams

Preferred: Project management and/or, healthcare contracting experience; clinical, pharmacy, 340B, or pharmacy benefit management knowledge

Traits: Organized, high-integrity, strict attention to detail, dependable, quality focus, empathetic, good listener/communicator, self-motivated

Other: Energetic, highly motivated, team player, extreme discretion and confidentiality are essential as this position deals with highly sensitive and private data in a HIPAA compliant environment

Solid computer skills are required, including proficiency in Microsoft Office tools (Outlook, Teams, Word, Excel, and PowerPoint) for communication, documentation, and data management, as well as, navigating the internet and web-based platforms. Data entry and computer skills will be evaluated through an assessment as part of the pre-employment process.

Shields Health Solutions provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Shields Health Solutions is committed to providing an inclusive hiring experience; if you need assistance or accommodation during the application or interview process, please email [e-mail].