Provider Relations Specialist

Location: Hybrid (Local to NYC or Denver Metropolitan areas)

Position Summary:

The Provider Relations Specialist provides essential credentialing review and management to support the Capital Rx networks of pharmacies. This work involves deciding whether pharmacies meeting Capital Rx's credentialing requirements allowing for inclusion in the Capital Rx pharmacy networks and maintaining the information related to credentialing. The ideal candidate will have experience in credentialing providers, managing reporting requests, and contribute to scalable solutions to streamline processes.

Position Responsibilities:

• Manage the standard credentialing review process for applicable pharmacies for inclusion in the provider networks andmaintainthe information related to credentialing so that Capital Rx has the most relevant information available. 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 requirements for Capital Rx.

• Manage,reviewand decide whether the applicable pharmacies are valid by reviewing exclusion lists on an ongoing basis toidentifyany excluded pharmacies and referring those pharmacies to theappropriate teammembers/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 andimplementof credentialing policies and procedures.

• Gather pertinent information from pharmaciesregardingservices offered and opportunities and provide direct contracting support to Provider Relations leadership as needed.
• Provide otherassistanceas assigned to the Provider Relations team.

Required Qualifications:

• 2+ yrs. of experience in healthcare, pharmacy credentialing, contracting, provider relations, pharmacy, accountmanagementor 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 communicationskills with the ability to develop effective working relationships with providers and internal and external stakeholders.
• Intermediate level ofproficiencywith Microsoft Excel, Word, PowerPoint.

Preferred Qualifications:

• PBM and pharmacy technician experience preferred

• Bachelor's degree preferred