Provider Relations Specialist
Judi Health, New York, NY, United States
Overview
About Judi Health
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including Capital Rx (PBM solutions for self-insured employers), Judi Health (health benefit management solutions for employers, TPAs, and health plans), and Judi®, the Enterprise Health Platform (EHP) that consolidates claim administration workflows in one scalable, secure platform. Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health.
Location : Hybrid (Local to NYC)
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 meet Capital Rx’s credentialing requirements for inclusion in the Capital Rx pharmacy networks and maintaining related credentialing information. The ideal candidate will have experience in credentialing providers, managing reporting requests, and contributing to scalable solutions to streamline processes.
Position Responsibilities
Manage the standard credentialing review process for applicable pharmacies for inclusion in the provider networks and maintain credentialing information so Capital Rx has the most relevant data available. This includes obtaining applicable licenses and certificates of insurance from pharmacies, verifying eligibility in the NCPDP database and federal/state websites (e.g., OIG, GSA, SAM), and using that information to determine whether the pharmacy meets credentialing requirements for Capital Rx.
Review exclusion lists on an ongoing basis to identify any excluded pharmacies and refer those pharmacies to the appropriate teams for removal.
Develop and maintain a credentialing database to ensure proper tracking of all relevant credentialing information.
Manage credentialing reporting requests.
Gather and track annual pharmacy attestations.
Develop and implement credentialing policies and procedures.
Gather pertinent information from pharmacies regarding services offered and opportunities, and provide direct contracting support to Provider Relations leadership as needed.
Provide other assistance as assigned to the Provider Relations team.
Required Qualifications
2+ years of experience in healthcare, pharmacy credentialing, contracting, provider relations, pharmacy, account management, or other relevant areas.
Proven ability to work in a fast-paced environment, manage multiple tasks, and perform persistent outreach to pharmacy providers to close contracts and tasks.
Ability to work independently, track work/projects, and stay on task.
Strong communication skills with the ability to develop effective working relationships with providers and internal/external stakeholders.
Intermediate proficiency with Microsoft Excel, Word, and PowerPoint.
Preferred Qualifications
PBM and pharmacy technician experience preferred
Bachelor’s degree preferred
New York, NY Salary Range: $56,800 USD - $71,000 USD
All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management to assign or reassign duties and responsibilities as needed to meet organizational goals.
Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by law.
By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. Details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.
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About Judi Health
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including Capital Rx (PBM solutions for self-insured employers), Judi Health (health benefit management solutions for employers, TPAs, and health plans), and Judi®, the Enterprise Health Platform (EHP) that consolidates claim administration workflows in one scalable, secure platform. Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health.
Location : Hybrid (Local to NYC)
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 meet Capital Rx’s credentialing requirements for inclusion in the Capital Rx pharmacy networks and maintaining related credentialing information. The ideal candidate will have experience in credentialing providers, managing reporting requests, and contributing to scalable solutions to streamline processes.
Position Responsibilities
Manage the standard credentialing review process for applicable pharmacies for inclusion in the provider networks and maintain credentialing information so Capital Rx has the most relevant data available. This includes obtaining applicable licenses and certificates of insurance from pharmacies, verifying eligibility in the NCPDP database and federal/state websites (e.g., OIG, GSA, SAM), and using that information to determine whether the pharmacy meets credentialing requirements for Capital Rx.
Review exclusion lists on an ongoing basis to identify any excluded pharmacies and refer those pharmacies to the appropriate teams for removal.
Develop and maintain a credentialing database to ensure proper tracking of all relevant credentialing information.
Manage credentialing reporting requests.
Gather and track annual pharmacy attestations.
Develop and implement credentialing policies and procedures.
Gather pertinent information from pharmacies regarding services offered and opportunities, and provide direct contracting support to Provider Relations leadership as needed.
Provide other assistance as assigned to the Provider Relations team.
Required Qualifications
2+ years of experience in healthcare, pharmacy credentialing, contracting, provider relations, pharmacy, account management, or other relevant areas.
Proven ability to work in a fast-paced environment, manage multiple tasks, and perform persistent outreach to pharmacy providers to close contracts and tasks.
Ability to work independently, track work/projects, and stay on task.
Strong communication skills with the ability to develop effective working relationships with providers and internal/external stakeholders.
Intermediate proficiency with Microsoft Excel, Word, and PowerPoint.
Preferred Qualifications
PBM and pharmacy technician experience preferred
Bachelor’s degree preferred
New York, NY Salary Range: $56,800 USD - $71,000 USD
All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management to assign or reassign duties and responsibilities as needed to meet organizational goals.
Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by law.
By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. Details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.
#J-18808-Ljbffr