Remote Pharmacy Credentialing & Payor Access Specialist

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

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.