Specialist, Medicaid Portal & Contract Administrator

About the role

The Specialist, Medicaid Portal & Contract Administrator plays a critical role within our Payor Access team, supporting payer contract compliance, including credentialing, recredentialing, contract maintenance, and reimbursement adherence. This position serves as a key liaison between the Contracting, Compliance, Quality, and Operations teams, ensuring accurate documentation, regulatory alignment, and efficient portal management to support organizational objectives.

Responsibilities

• Enrollment & Credentialing
• Oversee and maintain an efficient, effective process to ensure continuous enrollment in Medicaid programs and active credentialing status with all commercial and government payers across pharmacy locations.
• Contract & Compliance Tracking
• Maintain and archive key contract terms and critical dates within the client relationship management (CRM) platform.
• Generate and provide status reports to ensure organizational awareness and adherence to credentialing and enrollment deadlines.
• Regulatory Monitoring & Issue Resolution
• Monitor, research, resolve, and document requirements across external regulatory platforms, including Medicare, NCPDP, PECOS, NPI registration, and state Boards of Pharmacy.
• Proactively identify compliance gaps and provide updates on status and resolution progress.
• Corporate Compliance Support
• Support the Manager, Contract Compliance in executing corporate updates, including office and staffing changes, site licensing, and credentialing activities, for all pharmacy locations.
• Documentation & Records Management
• Develop and maintain a comprehensive, secure repository of corporate documentation, including:
• Ownership and governance records (board and director documentation).
• Delegation of signatory authority.
• Licensing and credentialing files.
• Maintain a confidential disclosure log of disciplinary actions from commercial and government payers that may impact licensing, enrollment status, or regulatory standing.

Requirements

• Education & Minimum Requirement
• Typically requires 4+ years of relevant experience.
• Critical Skills
• 4+ years’ experience in healthcare working in operational or compliance roles.
• In-depth knowledge of the healthcare and insurance markets, including reimbursement, pricing models, and regulatory compliance within highly regulated environments.
• Comprehensive experience in processing documentation, analysis, and continuous improvement initiatives.
• Proficient in Microsoft Office Suite, including use of Excel, Word, and PowerPoint.
• Experience utilizing Adobe tools for document management and presentation needs.

Qualifications

• Proactive and self-motivated, with a strong sense of initiative.
• Strong written and verbal communication skills, with the ability to convey complex information clearly and effectively.
• Hightly organized, detail-oriented, and diligent.
• Effective at prioritizing tasks and meeting deadlines in a fast-paced environment.
• Collaborative and customer-focused, with a commitment to delivering value.
• Strong critical thinking and problem-solving abilities.
• Experience documenting and improving processes.
• Knowledgeable in ensuring compliance with regulatory and operational requirements.
• Exceptional attention to detail paired with strong organizational and time management abilities.
• Proven analytical capabilities, including the ability to interpret large data sets, identify trends, and communicate actionable insights.
• Demonstrated ability to prioritize competing demands and consistently meet deadlines.
• Self-motivated with the ability to work independently while maintaining productivity and accountability.
• Collaborative and customer-focused, with a track record of delivering measurable value to internal and external stakeholders.

Benefits

We not only care about the wellbeing of our patients, customers and the communities we serve — we care about you. That’s why we provide our employees with a comprehensive support system for all aspects of Your Care: physical, emotional, financial and social.