Pharmacy Credentialing & Enrollment Specialist – Payer Networks

This is a fully remote position, open to applicants in United States.

📋 Description

• Evaluate and meet the clinical and operational reporting needs required by payor and PBM networks.

• Prepare and submit applications for specialty network access on behalf of Shields partners.

• Conduct both primary and secondary research to support contracting, payor access, and specialty formularies.

• Investigate pharmacy network access at the BIN/PCN/Group level utilizing test claims and other data-driven techniques.

• Assist with state licensing processes, including new applications, credentialing, and re-credentialing.

• Independently oversee multiple contracting and payor-access projects.

• Provide prompt customer service to partners regarding contracting and payor access inquiries.

• Identify solutions for unique requests and challenges.

• Safeguard organizational integrity by maintaining confidentiality.

• Perform additional duties as assigned.

⛳️ Requirements

• Experience with pharmacy claims, pharmacy benefit plans (BIN/PCN/Group), specialty medications, and models for specialty pharmacy clinical and operational care.

• Ability to convey results clearly and succinctly through Excel tables, emails, and PowerPoint presentations.

• Exceptionally organized and driven by data.

• Comfortable and effective in managing numerous concurrent workstreams.

• Strong computer skills required, including proficiency in Microsoft Outlook, Teams, Word, Excel, PowerPoint, and web-based platforms.

• Data entry and computer skills will be assessed through a pre-employment evaluation.

• Preferred: experience in project management and/or healthcare contracting.

• Preferred: knowledge in clinical, pharmacy, 340B, or pharmacy benefit management.

• Highly organized, dependable, attentive to detail, quality-focused, empathetic, an effective communicator, and self-motivated.

• Energetic and motivated team player; extreme discretion and confidentiality are essential.

• Ability to perform under deadlines and time constraints.

• Must be reliable, resilient, determined, and capable of collaborating within a close-knit team.

🏝️ Benefits

• Equal employment opportunities and protections against discrimination.

• Inclusive hiring process.

• Assistance and accommodations available for applications and interviews.

• HIPAA-compliant work environment.

• Text-message recruiting updates available with an opt-out option (consent not a condition of employment).