Description

Location: Onsite - Altamonte Springs FL

BioPlus Specialty Pharmacy is now part of CarelonRx (formerly IngenioRx), and a proud member of the Elevance Health family of companies . Together, CarelonRx and BioPlus offer consumers and providers an unparalleled level of service that’s easy and focused on whole health. Through our distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer’s treatment journey.

As a Credentialing Analyst you will be responsible for accurate and prompt credentialing for health plans and pharmacy benefit managers (PBM) for all pharmacy sites. Acts as a troubleshooter in resolving payor departmental issues related to credentialing. Manages LicenseTrak application to advise pharmacy sites and pharmacist of license renewals.

Primary duties may include, but are not limited to:

Performs credentials file audits to ensure timeliness of processing, quality of documentation, and adherence to company and department policies.
Performs quality review of files to determine accuracy and completeness of all necessary documentation for Medical Director and Credentials Committee.
Analyzes performance data to predetermined standards.
May also perform site visits of provider offices for participation in networks. Interacts with physicians, office managers, credentialing staff from other organizations to obtain information, provide status updates, research issues necessary for Credentials Committee review.
Utilizes internal systems and runs reports/queries to research provider questions and resolve issues. Monitors license actions, complaints, and sanctions and obtains necessary information for Managers review.
Prepares documentation for Medical Directors consideration of off-cycle review. Maintains provider peer review information on the credentialing database system.
Supports and tracks provider appeals process.
May assume responsibility for delegation oversight activities. Participates in accreditation survey preparation via data entry, reporting, and acting as task force liaison.
Manage PBM credentialing requests and maintenance.
Maintain NCPDP profile for all pharmacy sites.
Certificate of Insurance requests and dissemination to plans or CMS.
URAC, ACHC, NABP support during accreditation renewals

Minimum Requirements:

Requires a High School diploma and minimum of 3 years’ experience in a managed care environment; or any combination of education and experience, which would provide an equivalent background.
Strongly preferred certified Provider Credentialing Specialist and college course work.

Preferred Requirements:

Associate degree in healthcare related field preferred.
3+ years of experience of Medicare, Medicaid, and Managed care credentialing

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), 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.

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. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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 ability@icareerhelp.com for assistance.