Credentialing Specialist I, Amazon Pharmacy

Amazon.com • Austin, TX

355d • $50,100 - $107,200

About The Position

Amazon Pharmacy is committed to build the future of pharmacy by offering technology solutions that drive and enable us to be the world's most customer centric pharmacy option. The Payer Operations team is seeking an L4 Risk Manager to develop and execute foundational reporting, risk analysis, and tactical requests from internal stakeholders. This position will be heavily involved in cross-functional activity and external PBM & State Medicaid communications. This individual will build and scale operational processes for pharmacy credentialing and launches while ensuring alignment with 3P risks and regulatory requirements. Payers represent 88%+ of US prescription spend and a clean and organized input filing is a requisite for AP's success. This role is critical to AP as it is the primary mechanism to maintain payer credentials and reduce unintended network impacts. The ideal candidate will have a broad understanding of the healthcare sector with strong organizational skills, an analytical toolset to deep dive, create efficiencies, manage risk tolerances, and optimize existing policies.

Requirements

• 3+ years of experience managing financials/projects, Bachelor's degree.
• Experience in owning and navigating financial metrics in a disrupted industry.
• Ability to understand cross-function interdependence among partner teams.
• Advanced proficiency in MS Excel, Word, document writing.
• Basic understanding of the Pharmaceutical industry including PBMs, manufacturers, distributors, providers, and payers.
• Excellent communication/interpersonal skills, analytical and problem-solving skills.

Nice To Haves

• Credentialing and/or Risk Management experience.
• CPCS certification from NAMMS or Certified Risk Manager (CRM) is a plus.
• Strong quantitative skills and ability to dive deep into data to distill and communicate root cause.
• Strong ownership with ability to toggle between tactical and strategic activities.
• Manage and lead cross-functional meetings.
• Experience working for or with PBMs, manufacturers, distributors, or providers.

Responsibilities

• Streamline Payer & Medicaid credentialing and cross-team processes by introducing improved controls, enhancing operational efficiency, and successfully delivering projects.
• Manage upstream dependencies (Payer Relations, Compliance, Ops Compliance, Tax, Legal, Global Risk, Ops & Biz Tech), and downstream dependencies (FinOps, Reimbursement, Audit, Accounting, B2B, and Quality) to ensure timely & accurate collection, validation, and ultimately dissemination of information to external customers.
• Develop tracking mechanisms and implement risk management policies by partnering with Legal & Compliance stakeholder groups to proactively minimize identified risks and reactively address operational gaps.
• Improve existing processes iteratively and introduce new initiatives to help drive down risk while meeting compliance and policy requirements as it pertains to financial penalties, customer accessibility, insurance coverage of new FCs, electronic remittance, and payments.
• Handle day-to-day stakeholder inquiries, route payer correspondence to the relevant owners, and collaborate with partner teams to drive projects, while creating long-term scalable solutions that improve stakeholder accountability.
• Evaluate and address potential risks to the company with upstream and downstream stakeholder groups, including network termination, financial penalties, operational blockers, and payer compliance risks.
• Ensure compliance with relevant laws and regulations through collaboration with cross-functional teams.
• Work backwards with key stakeholders in developing proactive mechanisms in order to evaluate operational gaps and scope out new business initiatives, considering the potential risks and rewards.
• Provide expert guidance and support to team members on risk management escalation and issues.
• Stay informed of industry developments, changing regulations, and emerging risks in the pharmacy sector.

Benefits

• Equity, sign-on payments, and other forms of compensation may be provided as part of a total compensation package.
• Full range of medical, financial, and/or other benefits.

What This Job Offers

• Career Level: Mid Level
• Industry: General Merchandise Retailers
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees