Provider Relations Specialist

6 days, 2 hours ago
Full-time
Junior
Customer and Technical Support
Capital Rx

Capital Rx

Capital Rx provides comprehensive health benefit management and transparent pharmacy benefit management solutions, integrating various healthcare services to support millions of plan members across diverse sectors.

Health Care Providers & Services
251-1K
Founded 2017

Description

  • Manage the standard credentialing review process for pharmacies seeking inclusion in the provider networks.
  • Collect and verify licenses, certificates of insurance, and eligibility information from the NCPDP database and federal and state websites such as OIG, GSA, and SAM.
  • Determine whether pharmacies meet Capital Rx credentialing requirements.
  • Review exclusion lists on an ongoing basis and refer excluded pharmacies to the appropriate team members or departments for removal.
  • Develop and maintain a credentialing database to track all relevant credentialing information.
  • Manage credentialing reporting requests.
  • Gather and track annual pharmacy attestations required for credentialing.
  • Review and help implement credentialing policies and procedures.
  • Gather information from pharmacies about services and opportunities and provide direct contracting support to Provider Relations leadership as needed.
  • Provide additional support to the Provider Relations team as assigned.

Requirements

  • 2+ years of experience in healthcare, pharmacy credentialing, contracting, provider relations, pharmacy, account management, or other relevant experience.
  • Experience working in a fast-paced environment and managing multiple tasks simultaneously.
  • Ability to work independently, track work and projects appropriately, and remain on task.
  • Strong communication skills and the ability to build effective working relationships with providers and internal and external stakeholders.
  • Intermediate proficiency with Microsoft Excel, Word, and PowerPoint.
  • PBM and pharmacy technician experience preferred.
  • Bachelor’s degree preferred.

Benefits

  • Remote, US-based position.
  • Base salary range of $44,800 to $71,000 USD.
  • Salary is determined by experience, knowledge, skills, and location.

Interested in this position?

Apply directly on the company website

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