Credentialing Analyst

Location: Lake Mary, FL. You must live within a commutable distance of this location.

Schedule

General business hours, Monday through Friday. Hybrid—this role requires associates to be in-office 1-2 days per week.

Responsibilities

• Manages and maintains pharmacy license tracking tool to advise pharmacy sites and pharmacists of license renewals.
• Submits 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, protocols, standards, and requirements.
• Develops and fosters collaborative relationships with managed care plans, state agencies, and PBMs 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.
• Performs Medicaid portal maintenance and updates.
• Maintains NCPDP profile for all pharmacy sites.
• Handles Certificate of Insurance requests and dissemination to plans or CMS.
• Updates NPI profile (NPPES).
• Provides URAC, ACHC, NABP support during accreditation renewals.
• Submits Fraud, Waste, and Abuse annual attestation to health plans.
• Submits Pharmacist in Charge state license changes and renewals.
• Performs additional responsibilities as assigned.

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.

Qualifications

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

Benefits

• Market-competitive total rewards including merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement).
• Medical, dental, vision, short- and long-term disability benefits.
• 401(k) with company match, stock purchase plan, life insurance.
• Wellness programs and financial education resources.