[Hiring] Pharmacy Credentialing & Enrollment Specialist @Shields Health Solutions

Role Description

The Company is seeking a highly motivated, self-starter who is looking for a challenging career with a fast-growing company in the Healthcare Services sector. The Payor Access / Contracting Analyst is responsible for numerous workflows involved in establishing and maintaining specialty pharmacy payor contracts on behalf of each partnering health system.

• Play a key role in the assessment and fulfillment of clinical and operational reporting requirements mandated by payor and PBM networks.
• Participate in the preparation and submission of applications related to specialty network access on behalf of Shields partners.
• Conduct primary and secondary research in support of the contracting process, focusing on payor access and specialty formularies.
• Perform investigative research into pharmacy network access at the BIN/PCN/Group level, inclusive of running test claims and other data-driven methods.
• Support workstreams related to state licensing matters, including new applications, credentialing, and re-credentialing.
• Independently manage numerous workstreams related to contracting and payor access.
• Provide exceptional and timely customer service to our partners on all matters related to contracting and payor access.
• Identify solutions to non-standard requests and problems.
• Willingness to do whatever is necessary for the betterment of the Company.
• Protect organization's value by keeping information confidential.
• Other duties as assigned.

Qualifications

• Experience with pharmacy claims, pharmacy benefit plans (BIN/PCN/Group), specialty medications, and specialty pharmacy clinical and operational care models.
• Ability to communicate results in a clear and concise manner via Excel tables, email communication, and PowerPoint slides.
• Exceptionally organized and data-driven.
• Comfortable and successful handling numerous concurrent work streams.
• Preferred: Project management and/or healthcare contracting experience; clinical, pharmacy, 340B, or pharmacy benefit management knowledge.
• Traits: Organized, high-integrity, strict attention to detail, dependable, quality focus, empathetic, good listener/communicator, self-motivated.
• Other: Energetic, highly motivated, team player, extreme discretion and confidentiality are essential as this position deals with highly sensitive and private data in a HIPAA compliant environment.

Requirements

• Solid computer skills are required, including proficiency in Microsoft Office tools (Outlook, Teams, Word, Excel, and PowerPoint) for communication, documentation, and data management.
• Navigating the internet and web-based platforms.
• Data entry and computer skills will be evaluated through an assessment as part of the pre-employment process.

Benefits

• California residents employed by or applying for work at Shields have certain privacy rights.
• Shields Health Solutions provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type.
• Shields Health Solutions is committed to providing an inclusive hiring experience; if you need assistance or accommodation during the application or interview process, please email [email protected].