Provider Relations Specialist (Healthcare)

TL;DR

Provider Relations Specialist (Healthcare): Managing credentialing review and maintenance for pharmacy networks with an accent on regulatory compliance and database management. Focus on verifying eligibility via NCPDP and federal/state databases, streamlining reporting processes, and ensuring provider network integrity.

Location: Hybrid (Must be local to New York City or Denver Metropolitan areas)

Salary: $50,000 - $60,000 USD

Company

Enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including pharmacy benefit management (PBM) and health benefit management.

What you will do

• Manage the standard credentialing review process for pharmacies to ensure inclusion in provider networks.
• Verify pharmacy eligibility using NCPDP databases and federal/state websites such as OIG, GSA, and SAM.
• Maintain and develop a credentialing database for tracking relevant provider information.
• Monitor exclusion lists on an ongoing basis to identify and remove invalid pharmacies.
• Handle credentialing reporting requests and track annual pharmacy required attestations.
• Support the development and implementation of credentialing policies and procedures.

Requirements

• 2+ years of experience in healthcare, pharmacy credentialing, contracting, provider relations, or account management.
• Must be local to New York City or Denver Metropolitan areas.
• Strong communication skills and ability to build relationships with stakeholders.
• Intermediate proficiency in Microsoft Excel, Word, and PowerPoint.
• Ability to work independently in a fast-paced environment.

Nice to have

• Experience as a pharmacy technician or within a PBM.
• Bachelor's degree.

Culture & Benefits

• Commitment to rebuilding trust in the U.S. healthcare infrastructure.
• Diverse and inclusive workplace that celebrates employee diversity.
• Equal employment opportunity environment prohibiting discrimination and harassment.