Job Description
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, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,
Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and
Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related 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.
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 meeting Capital Rx’s credentialing requirements allowing for inclusion in the Capital Rx pharmacy networks and maintaining the information related to credentialing. The ideal candidate will have experience in credentialing providers, managing reporting requests, and contribute 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 the information related to credentialing so that Capital Rx has the most relevant information available. This includes getting applicable licenses and certificates of insurance from pharmacies as well as verifying eligibility in the NCPDP database and federal and state websites (e.g. OIG, GSA, SAM) and using that information to decide whether the pharmacy meets the credentialing requirements for Capital Rx.
Manage, review and decide whether the applicable pharmacies are valid by reviewing exclusion lists on an ongoing basis to identify any excluded pharmacies and referring those pharmacies to the appropriate team members/departments for removal.
Manage the development and maintenance of a credentialing database to ensure proper tracking of all relevant credentialing information.
Manage credentialing reporting requests.
Gather and track annual pharmacy required attestations.
Manage and review development and implement of 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+ yrs. of experience in healthcare, pharmacy credentialing, contracting, provider relations, pharmacy, account management or other relevant experience.
Proven track record of working in a fast-paced environment, managing multiple tasks at once and having a go-get attitude to provide persistent outreach to pharmacy providers to close out contracts and tasks.
Ability to work independently, track work/projects appropriately and remain on task.
Strong communication skills with the ability to develop effective working relationships with providers and internal and external stakeholders.
Intermediate level of proficiency with Microsoft Excel, Word, PowerPoint.
Preferred Qualifications:
PBM and pharmacy technician experience preferred
Bachelor’s degree preferred
This range represents the low and high end of the anticipated base salary range. The actual base salary will depend on several factors such as: experience, knowledge, skills, and location of the job.
Remote, US Salary Range
$44,800—$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 the opportunity to assign or reassign duties and responsibilities as needed to best 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 for employment 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 federal, state or local laws.
By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.