Credentialing Analyst Pharmacy

Credentialing Analyst Pharmacy

Credentialing Analyst Pharmacy

Location: 3200 Lake Emma Rd. Lake Mary, FL

Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

A proud member of the Elevance Health family of companies, CarelonRx (formerly IngenioRx) leverages the power of new technologies and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care.

The Credentialing Analyst Pharmacy is responsible for accurate and prompt credentialing for health plans and pharmacy benefit managers (PBM) for all pharmacy sites.

How you will make an impact:

• Acts as a troubleshooter in resolving payor departmental issues related to credentialing.
• Manages and maintains pharmacy license tracking tool to advise pharmacy sites and pharmacists of license renewals.
• 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 and protocols, standards, and requirements.
• Develops and fosters collaborative relationships with managed care plans, state agencies and PBM's 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.
• Medicaid portal maintenance and updates.
• Medicaid administrator user access for billing.
• Pull Medicaid remits for billing team upon request if portal access is limited.
• Manage PBM credentialing requests and maintenance. Medicare (PECOS) processing for all pharmacy sites.
• Maintain NCPDP profile for all pharmacy sites.
• Certificate of Insurance requests and dissemination to plans or CMS. NPI profile updates (NPPES).
• URAC, ACHC, NABP support during accreditation renewals.
• Fraud, Waste and Abuse annual attestation submission to health plans.
• Manage pharmacy Continuing Education Units for RFP's.
• Pull and maintain credentialing documents for payor applications.
• Knowledge of Medicaid, Medicare, Managed care and PBM providers.
• Additional responsibilities as assigned.
• Submit new pharmacy license applications and renewals for all pharmacy sites.
• Submit Pharmacist in Charge state license changes and renewals.

Minimum Requirements:

• Requires a H.S. diploma or equivalent and minimum of 3 years experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Strongly preferred certified Provider Credentialing Specialist and college course work.

Job Level: Non-Management Non-Exempt

Workshift:

Job Family: PND > Credentialing & Licensing

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs, medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.