Pharmacy Credentialing/Licensing Analyst at Elevance Health in FL-LAKE MARY, 3200 LAKE EMMA RD, STE 1000

Job description

• Credentialing Analyst Pharmacy
• LOCATION: Lake Mary, FL. You must live within a commutable distance of this location.
• HOURS: General business hours, Monday through Friday.
• Hybrid -This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.
• Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Responsibilities

• The Credentialing Analyst Pharmacy is responsible for accurate and prompt facility/professional licensing and/or credentialing for health plans and pharmacy benefit managers (PBM) for all pharmacy sites.
• Manages and maintains pharmacy license tracking tool to advise pharmacy sites and pharmacists of license renewals.
• Submit new pharmacy license applications and renewals for all pharmacy sites.
• Maintains confidentiality of all pertinent pharmacy and provider information.
• Administers credentialing and re-credentialing to ensure compliance with regulatory, accreditation and various managed care plan policies and protocols, standards, and requirements.
• Develops and fosters collaborative relationships with managed care plans, state agencies and PBM’s to facilitate timely credentialing and re-credentialing of applications.
• Tracks credentialing and re-credentialing to ensure compliance with time sensitive materials.
• Maintains all pharmacy site credentialing and re-credentialing files, electronic and paper.
• Effectively communicates with admission, billing, and clinical teams in a professional manner.
• Reviews all credentialing policies and procedures for accuracy and completeness.
• Suggests revisions of policies and procedures when necessary.
• Completes new Medicaid applications and renewals or revalidations.
• Medicaid portal maintenance and updates.
• Maintain NCPDP profile for all pharmacy sites.
• Certificate of Insurance requests and dissemination to plans or CMS.
• NPI profile updates (NPPES). URAC, ACHC, NABP support during accreditation renewals.
• Fraud, Waste and Abuse annual attestation submission to health plans.
• Additional responsibilities as assigned.
• Submit Pharmacist in Charge state license changes and renewals.

Requirements

• Requires a H.S. diploma and minimum of 3 years' experience; or any combination of education and experience, which would provide an equivalent background.
• Previous experience with pharmacy licensure with state pharmacy boards is strongly preferred.
• Knowledge of Medicaid, Medicare, Managed care and PBM providers is preferred.

Skills

Required

• H.S. diploma
• Minimum 3 years' experience

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.