Credentialing Analyst

Elevance Health•Lake Mary, FL

1d•Hybrid

About The Position

The Credentialing Analyst Pharmacy is responsible for accurate and prompt credentialing for health plans and pharmacy benefit managers (PBM) for all pharmacy sites. Primary duties may include, but are not limited to: Manages and maintains pharmacy license tracking tool to advise pharmacy sites and pharmacists of license renewals. Submit new pharmacy license applications and renewals for all pharmacy sites. Maintains confidentiality of all pertinent pharmacy and provider information. Administers credentialing and re-credentialing to ensure compliance with regulatory, accreditation and various managed care plan policies and protocols, standards, and requirements. Develops and fosters collaborative relationships with managed care plans, state agencies and PBM’s to facilitate timely credentialing and re-credentialing of applications. Tracks credentialing and re-credentialing to ensure compliance with time sensitive materials. Maintains all pharmacy site credentialing and re-credentialing files, electronic and paper. Effectively communicates with admission, billing, and clinical teams in a professional manner. Reviews all credentialing policies and procedures for accuracy and completeness. Suggests revisions of policies and procedures when necessary. Completes new Medicaid applications and renewals or revalidations. Medicaid portal maintenance and updates. Maintain NCPDP profile for all pharmacy sites. Certificate of Insurance requests and dissemination to plans or CMS. NPI profile updates (NPPES). URAC, ACHC, NABP support during accreditation renewals. Fraud, Waste and Abuse annual attestation submission to health plans. Additional responsibilities as assigned. Submit Pharmacist in Charge state license changes and renewals.

Requirements

Requires a H.S. diploma and minimum of 3 years' experience; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

Previous experience with pharmacy licensure with state pharmacy boards is strongly preferred.
Knowledge of Medicaid, Medicare, Managed care and PBM providers is preferred.

Responsibilities

Manages and maintains pharmacy license tracking tool to advise pharmacy sites and pharmacists of license renewals.
Submit new pharmacy license applications and renewals for all pharmacy sites.
Maintains confidentiality of all pertinent pharmacy and provider information.
Administers credentialing and re-credentialing to ensure compliance with regulatory, accreditation and various managed care plan policies and protocols, standards, and requirements.
Develops and fosters collaborative relationships with managed care plans, state agencies and PBM’s to facilitate timely credentialing and re-credentialing of applications.
Tracks credentialing and re-credentialing to ensure compliance with time sensitive materials.
Maintains all pharmacy site credentialing and re-credentialing files, electronic and paper.
Effectively communicates with admission, billing, and clinical teams in a professional manner.
Reviews all credentialing policies and procedures for accuracy and completeness.
Suggests revisions of policies and procedures when necessary.
Completes new Medicaid applications and renewals or revalidations.
Medicaid portal maintenance and updates.
Maintain NCPDP profile for all pharmacy sites.
Certificate of Insurance requests and dissemination to plans or CMS.
NPI profile updates (NPPES).
URAC, ACHC, NABP support during accreditation renewals.
Fraud, Waste and Abuse annual attestation submission to health plans.
Submit Pharmacist in Charge state license changes and renewals.