other
Posted May 4Provider Relations Specialist
at Judi Health
Remote
Responsibilities
- Manage the standard credentialing review process for applicable pharmacies for inclusion in the provider networks and maintain the information related to credentialing so that Capital Rx has the most relevant information available.
- Manage, review and decide whether the applicable pharmacies are valid by reviewing exclusion lists on an ongoing basis to identify any excluded pharmacies and referring those pharmacies to the appropriate team members/departments for removal.
- Manage the development and maintenance of a credentialing database to ensure proper tracking of all relevant credentialing information.
- Manage credentialing reporting requests.
- Gather and track annual pharmacy required attestations.
- Manage and review development and implement of credentialing policies and procedures.
Requirements
- Judi® , the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.
- experience in credentialing providers, managing reporting requests, and contribute to scalable solutions to streamline processes. Position
- experience in healthcare, pharmacy credentialing, contracting, provider relations, pharmacy, account management or other relevant experience.
- Proven track record of working in a fast-paced environment, managing multiple tasks at once and having a go-get attitude to provide persistent outreach to pharmacy providers to close out contracts and tasks.
- Ability to work independently, track work/projects appropriately and remain on task.
- Strong communication skills with the ability to develop effective working relationships with providers and internal and external stakeholders.
- Intermediate level of proficiency with Microsoft Excel, Word, PowerPoint. Preferred
- Bachelor’s degree preferred
Benefits
- This includes getting applicable licenses and certificates of insurance from pharmacies as well as verifying eligibility in the NCPDP database and federal and state websites (e.g. OIG, GSA, SAM) and using that information to decide whether the pharmacy meets the credentialing