Pharmacy Credentialing & Enrollment Specialist (Payer Networks)

Job Purpose:

The Company is seeking a highly motivated, self-starter who is looking for a challenging career with a fast-growing company in the Healthcare Services sector. Applicant should be results-oriented with a positive outlook, and a clear focus on high quality. A natural forward-planner who critically assesses own performance. Mature, credible, well-presented, professional and comfortable in dealing with others both in-person and on the phone. Critical to this position is a person who is able to work well under deadlines and time pressures. Applicant must be reliable, tolerant, and determined; an empathetic communicator, able to see things from the other person's point of view. Most importantly, person must be able to work as a member of a close-knit team.

The Payor Access / Contracting Analyst is responsible for numerous workflows involved in establishing and maintaining specialty pharmacy payor contracts on behalf of each partnering health system.

Job Duties:

• Play a key role the assessment and fulfillment of clinical and operational reporting requirements mandated by payor and PBM networks
• Participate in the preparation and submission of applications related to specialty network access on behalf of Shields partners;
• Conduct primary and secondary research in support of the contracting process; with a focus on payor access and specialty formularies
• Perform investigative research into pharmacy network access at the BIN/PCN/Group level; inclusive of running test claims and other data-driven methods
• Support workstreams related to state licensing matters, including new applications, credentialing, and re-credentialing;
• Independently manage numerous workstreams related to contracting and payor access;
• Provide exceptional and timely customer service to our partners on all matters related to contracting and payor access;
• Identify solutions to non-standard requests and problems;
• Willingness to do whatever is necessary for the betterment of the Company;
• Protect organization's value by keeping information confidential;
• Other duties as assigned;

Experience/ Education:

• Experience with pharmacy claims, pharmacy benefit plans (BIN/PCN/Group), specialty medications, and specialty pharmacy clinical and operational care models
• Ability to communicate results in a clear and concise manner via Excel tables, email communication, and PowerPoint slides
• Exceptionally organized and data driven
• Comfortable and successful handling numerous concurrent work streams

Preferred: Project management and/or, healthcare contracting experience; clinical, pharmacy, 340B, or pharmacy benefit management knowledge

Traits: Organized, high-integrity, strict attention to detail, dependable, quality focus, empathetic, good listener/communicator, self-motivated

Other: Energetic, highly motivated, team player, extreme discretion and confidentiality are essential as this position deals with highly sensitive and private data in a HIPAA compliant environment