Senior Credentialing Specialist

Onco360•Louisville, KY

3d•Hybrid

About The Position

Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. This role is a hybrid position. A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion. We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.

Requirements

Associates Degree in Accounting, Healthcare Administration, Business or Law.
At least three (3)) years of pharmacy licensure experience, as well as Medicare and Medicaid enrollment experience as a healthcare provider.
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.
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 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.

Nice To Haves

Bachelor’s degree in Accounting, Healthcare Administration, Business or Law.
Experience of legal terminology as related to the healthcare industry.
Driven, energetic individual with experience of operating within the professional standards of a large pharmaceutical company.

Responsibilities

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.
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), participation problem research and resolution as well as communication of new enrollments to Reimbursement and Operations teams.
NCPDP enrollment and updates.
Maintain online and complete all credentialing requests for the same.
NPI enrollment and updates with NPPES.
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 in an effort to maintain consistent and accurate facility information.
Execute such other functions as delegated by the Reimbursement Director or Manager.