Payer Credentialing Specialist

Are you someone looking for professional career growth? Onco360 Pharmacy is looking for a Payer Credentialing Specialist for our Pharmacy located in Woodridge, IL .
Work Hours: Monday to Friday - from 8:00am to 4:30pm CST
Starting salary at $26/HR and up We also offer quarterly incentive bonuses.
We offer a variety of benefits including:

• Medical, Dental & Vision insurance
• 401k with a match
• Paid Time Off and Paid Holidays
• Tuition Reimbursement
• Paid Volunteer Day
• Floating Holiday
• Referral Incentive
• Paid Life, and short & long-term disability insurance

Payer Credentialing Specialist Summary

• Ensure each pharmacy is properly and continuously credentialed for all payers, including but not limited to Medicare (PECO system), State Medicaid, PBM, Medicare D and Commercial payers.
• Maintain online profile through National Council for Prescription Drug Programs (NCPDP) and National Plan & Provider Enumeration System (NPPES) for National Provider Identifier (NPI) enrollment.

Payer Credentialing Specialist Major Responsibilities

• Medicare and Medicaid enrollment and updates, including establishment of Electronic Funds Transfer (EFT) and Electronic Data Interchange (EDI) allowing claims to be submitted & R/As retrieved electronically).
• NCPDP enrollment and updates. Maintain online and complete all credentialing requests for the same.
• Completion and management of health plan/PBM enrollment applications for both group and individual providers. Responsible for specific states and PBM plans, ensuring compliance and timely completion of applications.
• Tracking application progress, identifying potential issues, and proposing solutions for delays or rejections. Manage participation problem research and resolution as well as communication of new enrollments to Reimbursement and Operations teams.
• Work with providers in person, by phone, fax, mail or email to obtain provider credentialing and insurance enrollment forms and all supporting documentation. Respond to inquiries from other healthcare organizations regarding credentialing and privileging issues as they arise.
• Maintain central repository for all payer credentialing and pharmacy information and serve as liaison to Operations and Compliance teams for data needed.
• Provide operating data (# of facilities, states operated/licensed, states of participation in Medicaid, etc.) for reporting purposes, including annual dispensing surveys as well as Quarterly & Annual Financial reports.
• Serve as primary resource of facility ownership, name and address information for countless purposes throughout the company. Communicate pharmacy changes/closing/openings throughout the company to maintain consistent and accurate facility information.
• Execute other functions as delegated by VP RCM, Sr. Reimbursement Manager or designee.

Education/Work Experience

• Required: At least 3+ years of pharmacy enrollment/licensure experience, as well as Medicare and Medicaid enrollment experience as a healthcare provider.
• Desired: Associate or bachelor's degree in healthcare administration, Business or Law.

Skills/Knowledge

• Required: Knowledge of DEA and State Boards of Pharmacy licensure requirements, Medicare and state Medicaid enrollment process. Familiarity with NCPDP & NPPES organizations and enrollment processes. Superior analytical, oral and written communication, problem solving, organizational and planning skills. Ability to assist Company with acquisitions by providing licensure assessment as part of the due diligence process. Monitor adherence to all licensing policies as well as expiration dates of each license and ensure timely renewal. Proficient in Microsoft Office software, including Excel, Outlook and Word.
• Desired: Experience of legal terminology as related to the healthcare industry.

Behavior Competencies

• Required: Able to perform effectively, efficiently and accurately in a fast-paced dynamic corporate environment. Able to form and cultivate relationships within the company and with federal and state agency personnel to perform the job to these standards. Ability to recognize and maintain confidential information related to development activities and strategic planning of the company. Ability to re-focus attention immediately and unexpectedly for problem resolution. Demonstrated ability to work effectively and congenially with employees at all levels within the organization. Strong project management skills.
• Desired: Driven, energetic individual with experience of operating within the professional standards of a large pharmaceutical company.