CarepathRx
CarepathRx transforms hospital pharmacy from a cost center into an active revenue generator through a powerful combination of technology, market-leading pharmacy services and wrap-around services.
Job Details:
Responsible for preparing and submitting accurate credentialing and contract documents for health plans, pharmacy benefit managers (PBM) for all pharmacy locations. Assists to resolve pharmacy operations questions related to payor credentialing; develop performance improvement plans as needed. Communicate effectively with internal teams and establish contacts with health plans, PBMs, and external customers.
Responsibilities
Provide peer review analysis of enrollment and credentialing documents Prepare and submit new enrollment applications and credentialing packages for Medicaid, PBMs, and other payors. Administer credentialing and re-credentialing to ensure compliance with regulatory, accreditation and various payor policies and protocols, standards and requirements Develop and foster collaborative relationships with managed care plans, state agencies and PBMs to facilitate timely credentialing Collaborate with billing operations to resolve credentialing related payor contract reimbursement and contracted service issues Request network contracts by calling payors, providing timely responses and requested documentation Track and manage payor credentialing to ensure compliance with time sensitive materials Participate and perform other related duties as assigned Skills & Experience
Strong knowledge of pharmacy enrollment and credentialing process Must be able to meet time-sensitive deadlines, handle confidential and sensitive information appropriately Ability to lead and perform daily responsibilities in a collaborative team environment Demonstrate skills in attention to detail, organization, prioritizing and multitasking Provide exceptional customer service to internal and external business partners Demonstrate excellent oral and written communication skills Proficiency in Microsoft Word, Excel, and Outlook Qualifications
Associate's degree in healthcare related field preferred 5+ years of experience with credentialing health plan, pharmacy benefit manager (PBM), and Medicaid
CarepathRx offers a comprehensive benefit package for full-time employees that includes medical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits, 401(k), Paid Time Off and paid holidays. Medical, dental and vision coverage are effective 1st of the month following date of hire.
CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants encouraged to confidentially self-identify when applying.
Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.
Job Details:
Responsible for preparing and submitting accurate credentialing and contract documents for health plans, pharmacy benefit managers (PBM) for all pharmacy locations. Assists to resolve pharmacy operations questions related to payor credentialing; develop performance improvement plans as needed. Communicate effectively with internal teams and establish contacts with health plans, PBMs, and external customers.
Responsibilities
Provide peer review analysis of enrollment and credentialing documents Prepare and submit new enrollment applications and credentialing packages for Medicaid, PBMs, and other payors. Administer credentialing and re-credentialing to ensure compliance with regulatory, accreditation and various payor policies and protocols, standards and requirements Develop and foster collaborative relationships with managed care plans, state agencies and PBMs to facilitate timely credentialing Collaborate with billing operations to resolve credentialing related payor contract reimbursement and contracted service issues Request network contracts by calling payors, providing timely responses and requested documentation Track and manage payor credentialing to ensure compliance with time sensitive materials Participate and perform other related duties as assigned Skills & Experience
Strong knowledge of pharmacy enrollment and credentialing process Must be able to meet time-sensitive deadlines, handle confidential and sensitive information appropriately Ability to lead and perform daily responsibilities in a collaborative team environment Demonstrate skills in attention to detail, organization, prioritizing and multitasking Provide exceptional customer service to internal and external business partners Demonstrate excellent oral and written communication skills Proficiency in Microsoft Word, Excel, and Outlook Qualifications
Associate's degree in healthcare related field preferred 5+ years of experience with credentialing health plan, pharmacy benefit manager (PBM), and Medicaid
CarepathRx offers a comprehensive benefit package for full-time employees that includes medical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits, 401(k), Paid Time Off and paid holidays. Medical, dental and vision coverage are effective 1st of the month following date of hire.
CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants encouraged to confidentially self-identify when applying.
Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.