Pharmacy Credentialing/Licensing Analyst
About The Position
The Credentialing Analyst Pharmacy is responsible for accurate and prompt facility/professional licensing and/or credentialing for health plans and pharmacy benefit managers (PBM) for all pharmacy sites. This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
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.
- Additional responsibilities as assigned.
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
