This job has closed.

Elevance Health · 3 days ago

Credentialing Analyst Pharmacy (BioPlus)

Indianapolis, IN

Full-time

Hybrid

Mid Level

3+ years exp

Elevance Health is a health company dedicated to improving lives and communities. The Credentialing Analyst Pharmacy (BioPlus) is responsible for accurate and prompt credentialing for health plans and pharmacy benefit managers for all pharmacy sites, ensuring compliance with regulatory and accreditation requirements.

Health CareHealth InsurancePersonal HealthWellness

H1B Sponsor Likely

Responsibilities

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

Qualification

Provider Credentialing SpecialistMedicaid knowledgeMedicare knowledgeManaged care knowledgePBM knowledgeCommunication skillsCollaboration skillsAttention to detail

Required

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