Description

Location: (Onsite) Must reside within 50 miles of 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 Biller, you will be responsible for reviewing account files to ensure accuracy and completeness, and maximum reimbursement.

The Credentialing Analyst Pharmacy is responsible for accurate and prompt credentialing for health plans and pharmacy benefit managers (PBM) for all pharmacy sites.

Primary duties may include, but are not limited to:

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.
Submit new pharmacy license applications and renewals for all pharmacy sites.
Submit Pharmacist in Charge state license changes and renewals.
Additional responsibilities as assigned.

Qualifications - External

Primary requirements:

Requires a H.S. diploma
Minimum of 3 years experience;
Any combination of education and experience, which would provide an equivalent background.

Preferred requirements:

Strongly preferred certified Provider Credentialing Specialist and college course work.

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.

Credentialing Analyst Pharmacy - (ONSITE - FL, ALTAMONTE SPRINGS)

Description

Location: (Onsite) Must reside within 50 miles of Altamonte Springs, FL

The Credentialing Analyst Pharmacy is responsible for accurate and prompt credentialing for health plans and pharmacy benefit managers (PBM) for all pharmacy sites.

Primary duties may include, but are not limited to:

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.

Submit new pharmacy license applications and renewals for all pharmacy sites.

Submit Pharmacist in Charge state license changes and renewals.

Additional responsibilities as assigned.

Qualifications - External

Primary requirements:

Requires a H.S. diploma

Minimum of 3 years experience;

Any combination of education and experience, which would provide an equivalent background.

Preferred requirements:

Strongly preferred certified Provider Credentialing Specialist and college course work.

Be part of an Extraordinary Team