Provider Credentialing Specialist — Drive Network Compliance

Capital Rx Inc.; New York (NY); Hybrid; USD 47,000 - 71,000; Full time

Job summary

Judi Health seeks a Provider Relations Specialist to support credentialing for its Judi Rx network of pharmacies. You will evaluate licenses, maintain credentialing data, and support contracting for provider relations leadership in a six-month, potentially full-time role.

The position is hybrid with in-office days in NYC, Denver, or Charlotte and requires the ability to work across multiple systems and teams to ensure network integrity and compliance.

Qualifications

• Bachelor's degree preferred.
• 2+ yrs. of experience in healthcare, pharmacy credentialing, contracting, provider relations, pharmacy, account management or other relevant experience.
• Intermediate level of proficiency with Microsoft Excel, Word, PowerPoint.
• Proven track record of working in a fast-paced environment, managing multiple tasks at once and having a go-get attitude to provide persistent outreach to pharmacy providers to close out contracts and tasks.
• Ability to work independently, track work/projects appropriately and remain on task.
• Strong communication skills with the ability to develop effective working relationships with providers and 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.
• Verify licenses and certificates of insurance from pharmacies and check eligibility in the NCPDP database and federal/state websites (e.g. OIG, GSA, SAM).
• Review exclusion lists on an ongoing basis to identify any excluded pharmacies and refer those to the appropriate teams for removal.
• Develop and maintain a credentialing database to track all relevant credentialing information.
• Handle credentialing reporting requests with internal teams.
• Track annual pharmacy attestations to ensure contractual and accreditation compliance.
• Develop credentialing policies and procedures.
• Gather information from pharmacies regarding services offered and provide direct contracting support to Provider Relations leadership.

Skills

Healthcare experience

Credentialing experience

Excel proficiency

Communication skills

Independent worker

Education

Bachelor's degree preferred

Tools

Microsoft Excel

Microsoft Word

PowerPoint

Job description

Judi Health seeks a Provider Relations Specialist to support credentialing for its Judi Rx network of pharmacies. You will evaluate licenses, maintain credentialing data, and support contracting for provider relations leadership in a six-month, potentially full-time role.

The position is hybrid with in-office days in NYC, Denver, or Charlotte and requires the ability to work across multiple systems and teams to ensure network integrity and compliance.