Full-Time
Credentialing Analyst
Posted on 5/1/2024
Digital pharmacy benefits management platform
Junior, Mid, Senior, Expert
San Juan County, UT, USA
- Bachelor's Degree or Master's Degree in a related field.
- 3+ years of experience in Credentialing or Pharmacy Network Management.
- Experience developing and maintaining effective relationships with providers.
- Experience maintaining high level of confidentiality.
- Excellent oral and written communication skills.
- Serve as a subject matter expert (SME) of the credentialing and recredentialing processes within the pharmacy network.
- Conduct ongoing credentialing and re-credentialing processes and ensure compliant and timely revision of all relevant applications.
- Review and ensure that all necessary licenses and credentials are verified and timely updated.
- Ensure compliance with State and Federal regulations, especially those that apply to credentialing and CMS Stars Rating Program.
- Support Network Strategy team on issues and resolutions related to credentialing, contracting, enrollment, and termination of providers within the pharmacy network.
- Assist and maintain collections of data, tracking, and reporting for credentialing and third-party vendor in accordance with internal policies and procedures.
- Maintain cooperation and compliance with all regulatory and accrediting organizations.
- Create plans of action for assigned projects, including but not limited to workflow and quality improvements.
- Assist in the development and delivery of trainings related to credentialing and third-party oversight initiatives.
- Document activities, interventions, and issue resolutions according to internal policies for providers and third-party vendors.
- Assist with Network Strategies- Provider Relations projects and with training to other staff members.
- Assist with Pharmacy Complaints and Grievances as well as Medicaid Provider Enrollment.
Abarca Health offers a cutting-edge PBM technology platform, Darwin™, and a unique pricing solution, Assura, both designed to enhance predictability and transparency in managing drug spend. This focus on making drug costs more manageable not only sets the company apart in the pharmaceutical industry but also creates a workplace culture centered around innovation and client satisfaction. Employees can take pride in contributing to a company that directly influences the affordability and accessibility of healthcare, making it an excellent place for those looking to make a meaningful impact in the sector.
Company Stage
N/A
Total Funding
N/A
Headquarters
San Juan, Puerto Rico
Founded
2005
6 month growth
↑ 9%1 year growth
↑ 15%2 year growth
↑ 28%Benefits
PTO
Parental leave
Work flexibility
Health insurance
Wellness stipend
401k
Tuition reimbursement
Leadership development programs