Credentialing Specialist

Job Summary

A company is looking for a Credentialing Specialist to manage credentialing processes for a specialty pharmacy organization.

Key Responsibilities

• Lead the credentialing and recredentialing processes for specialty pharmacies
• Prepare and manage credentialing submissions for major PBMs and health plans
• Collaborate with various departments to support payer network participation and maintain provider status

Required Qualifications

• Bachelor's degree or equivalent combination of education/experience
• 5 years' experience in healthcare credentialing, with at least 2 years specific to PBMs and health plans
• Familiarity with CAQH ProView, NPPES, PECOS, and Medicare/Medicaid enrollment portals
• Working knowledge of specialty pharmacy operations and payer network participation
• Experience supporting specialty pharmacy services is preferred