Senior Credentialing Manager, Amazon Pharmacy

Innovation is at the core of what we do. We believe that by removing and reducing the barriers that prevent people from taking their medications, we can help customers conveniently get the medications they need, when they need them and take them as prescribed.

We have provided customers with the ability to find transparent and simple pricing, receive 24/7 customer service support, and have their meds delivered to their doorsteps while creating programs and products that embody our mission and position ourselves in becoming the world’s safest and
fastest online pharmacy.

The Pharmacy Payer team is part of the greater Pharmacy Organization, is seeking an L6 Credentialing Manager (individual contributor role) to develop and manage reporting, KPIs, and initiatives that reduce payer compliance risk to AP. Payers represent 88%+ of US prescription spend and a clean and organized input filing is a requisite for Amazon Pharmacy's (AP) success.

This role is critical to AP as it is the primary mechanism to maintain payer credentials and reduce unintended network impacts. Given AP’s nuanced corporate legal structure and multiple data systems, this role requires high judgement skills (or “are right a lot”) to determine pharmacy-network dependencies, pulse data accuracy, and captain the Payer Org to reduce adverse downstream impacts to patients.

Key job responsibilities
Manage a credential specialist team to review all technical inputs that determine AP’s insurance network coverage. Work with Compliance/legal teams to ensure uninterrupted network growth.

Represent AP for all Payer inputs and collaborate with external PBM stakeholders to ensure that all existing and prospective opportunity requirements are met from a corporate structure and tax perspective.

Work cross functionally with other Payer Biz Dev teams to deliver completion of inputs for commercial contracts and Medicaid state government applications.

Represent AP in Payer conferences and understand policy changes that could impact payer networks.

Advise and analyze customer transfer data between FCs and act as a consultant for FC operations to maximize patient coverage and maintain payer contract compliance.

Oversee Medicaid credentialing for all AP applicable states. Work with all Medicaid states to ensure opportunities for incremental Medicaid/MCO network opportunities.

Manage and risk mitigate all EDI payments flowing in from all payer networks.

Manage weekly AP Legal deliverables and act as mouthpiece for AP to address payer inquiries.

Document standard operating procedures for the Payer and Medicaid credentialing process to scale operations and increase expansion speed.

We are open to hiring candidates to work out of one of the following locations:

Austin, TX, USA

Basic Qualifications

- 2+ years of specific experience managing PBM/Payer credentialing inputs.
- 6+ years of experience managing healthcare administration
- Bachelor’s degree
- Experience developing business relationship from inception to launch
- Ability to understand cross-function interdependence among partner teams
- Advanced proficiency in MS Excel, Word, document writing

Preferred Qualifications

- Experience in leading credentialing team or national chain store pharmacy data.
- CPCS® certification from NAMMS
- Strong quantitative skills and ability to coach others to dive deep and distill/communicate root cause
- Strong management experience and ability to focus on micro/macro factors while influencing other organizations

Amazon is committed to a diverse and inclusive workplace. Amazon is an equal opportunity employer and does not discriminate on the basis of race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status. For individuals with disabilities who would like to request an accommodation, please visit https://www.amazon.jobs/en/disability/us.