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 data accuracy. Focus on verifying provider eligibility via NCPDP and federal/state databases, implementing credentialing policies, and optimizing provider onboarding workflows.

Location: Remote (Must be based in the US)

Salary: $44,800 - $71,000 USD

Company

Enterprise health technology company providing comprehensive pharmacy benefit management (PBM) and health benefit solutions for employers and health plans.

What you will do

• Execute the standard credentialing review process for pharmacies to determine network eligibility.
• Verify provider status using the NCPDP database and federal/state websites such as OIG, GSA, and SAM.
• Develop and maintain a credentialing database to track all relevant provider information.
• Manage reporting requests and gather annual pharmacy attestations.
• Implement and review credentialing policies and procedures to ensure compliance.
• Provide direct contracting support to Provider Relations leadership.

Requirements

• 2+ years of experience in healthcare, pharmacy credentialing, provider relations, or account management.
• Must be based in the United States.
• Proven ability to manage multiple tasks and conduct persistent outreach in a fast-paced environment.
• Strong communication skills for building relationships with internal and external stakeholders.
• Intermediate proficiency with Microsoft Excel, Word, and PowerPoint.

Nice to have

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

Culture & Benefits

• Fully remote work arrangement.
• Commitment to a diverse and inclusive workplace.
• Equal employment opportunity environment.