Pharmacy Credentialing Analyst - Remote

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Pharmacy Credentialing Analyst - Remote

Job Description

The Credentialing Analyst is responsible for improving the integrity of Prime’s pharmacy network by performing oversight of all credentialing reviews of pharmacy providers. This role will act as a subject matter expert on behalf of the pharmacy credentialing team to drive continuous improvement and serve as a point of escalation for pharmacy provider inquiries.

Responsibilities

• Review and approve all recommended decisions to ensure adherence to regulatory & compliance requirements as well as Prime’s policies and procedures; present pharmacy provider approvals and denials to Prime’s Credentialing Prep Committee
• Serve as a subject matter expert on the credentialing processes & technology for credentialing team, cross-functional projects and process improvement initiatives
• Analyze relevant data on pharmacy providers in Prime’s network to identify potential FWA schemes; recommend and implement new Prime credentialing requirements
• Ensure timely resolution of escalated credentialing issues and client audit requests
• Provide telephonic education to pharmacy providers on credentialing policies, procedures, and regulatory requirements
• Review & present recommended credentialing decisions for pharmacy provider appeals and terminations to Prime’s Credentialing Committee for final determination
• Responsible for collecting and responding to Requests for Information (RFI) and subpoenas
• Other duties as assigned
  
  

Minimum Qualifications

• Bachelor’s degree in Business, Health Information Management or related area of study, or equivalent combination of education and relevant work experience; HS diploma or GED is required
• 3 years of work experience in credentialing, auditing, investigations, accreditation, compliance, or other highly regulated function
• Must be eligible to work in the United States without need for work visa or residency sponsorship
  
  

Additional Qualifications

• Demonstrated ability to complete projects independently and within established timeframes
• Detail oriented and ability to work with a high degree of accuracy
• Expert ability to communicate effectively and present complex information to a wide variety of audiences
• Expert problem solving and troubleshooting skills
• Advanced organizational skills with the ability to work on multiple tasks and projects simultaneously
• Advanced proficiency within MS Office such as Access, Excel, PowerPoint, and Word
  
  

Preferred Qualifications

• PBM or pharmacy experience
• Certified Provider Credentialing Specialist (CPCS)
• Certified Professional Medical Services Management (CPMSM)
• National Pharmacy Technician Certification (CPhT)
  
  

Minimum Physical Job Requirements

• Constantly required to sit, use hands to handle or feel, talk and hear
• Frequently required to reach with hands and arms
• Occasionally required to stand, walk and stoop, kneel, and crouch
• Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
  
  

Reporting Structure

• Reports to a Manager in Supply Chain organization
  
  

Potential pay for this position ranges from $57,600.00 - $86,800.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.

Positions will be posted for a minimum of five consecutive workdays.

Salary : $57,600 - $86,800