Credentialing Analyst - Pharmacy

Job Type Part-time Description

AdaptHealth Opportunity – Apply Today!

At AdaptHealth we offer full-service home medical equipment products and services to empower patients to live their best lives – out of the hospital and in their homes. We are actively recruiting in your area. If you are passionate about making a profound impact on the quality of patients’ lives, please click to apply, we would love to hear from you.

Credentialing Analyst

The Credentialing Analyst - Pharmacy is responsible for assisting with pharmacy contracting and credentialing projects within the credentialing department. Supports Director,  with ongoing maintenance of contracts and supporting resources.

Job Duties:

• Completes pharmacy credentialing, recredentialing, and contract applications.
• Maintains Master Contracting/Credentialing Log.
• Monitors pharmacy contract renewal dates and reaches out to payers to set up meetings when contracts are up for renewal.
• Maintains current master agreements, announcements, and provider manual updates on Sharepoint. Distributes updates to applicable departments within AdaptHealth.
• Assists and coordinates with credentialing team to ensure payors are updated regularly on AdaptHealth business changes and credentialing status. Works with payers on fixing their contract databases to resolve out of network denials.
• Ensures accurate and timely EFT setup for all contracts.
• Coordinates with payors to organize meetings and enhance communications.
• Assists with developing and analyzing patient census, fee schedule, and utilization reporting for contract negotiations.
• Maintains pharmacy contract contact information.
• Coordinates and assists billing and other areas to resolve claims and pricing problems with payors.

Competency, Skills and Abilities:

• Excellent oral and written communication skills
• PBM knowledge
• Credentialing knowledge of multiple state credentialing and re-credentialing regulations
• Knowledge of all major insurance carrier contracting and reimbursement guidelines
• Ability to read and interpret documents such as contracts, credentialing, and other network management documents
• Excellent interpersonal and technical support skills
• Excellent organizational skills and attention to detail
• Strong analytical and problem-solving skills
• Conflict resolution skills
• Effective time management and multi-tasking skills
• Ability to influence and drive change
• Proficient computer skills and knowledge of Microsoft Office
• Ability to prioritize and manage multiple projects
• Ability to travel when needed, up to 15%

Requirements

Minimum Job Qualifications:

• High school diploma or equivalent required, Associates degree or higher preferred
• 2 years of contracting, credentialing, or other network management experience required

AdaptHealth is an equal opportunity employer and does not unlawfully discriminate against employees or applicants for employment on the basis of an individual’s race, color, religion, creed, sex, national origin, age, disability, marital status, veteran status, sexual orientation, gender identity, genetic information, or any other status protected by applicable law. This policy applies to all terms, conditions, and privileges of employment, including recruitment, hiring, placement, compensation, promotion, discipline, and termination.