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Pharmacy Credentialing and Contract Representative II

Company: Centene
Location: Fresno
Posted on: August 17, 2019

Job Description:

Pharmacy Credentialing and Contract Representative II Position Purpose: Ensure smooth implementation of new and expanding network by providing consultative on boarding for new pharmacies, chains, and pharmacy service administrative organizations (PSAO's). Performs all provider credentialing verifications and credentialing support tasks. - Assess and track the process of all credentialing materials - Perform review and analysis of incoming documents to determine completeness of applications and contractual documents and obtain missing documents for processing - Completes primary source verifications based on the requirements of each provider professional level - Maintain and update credentialing database - Act as a resource for staff to ensure adequate communication to the pharmacy provider network - Utilize effective communications to respond to heavy volume of emails, faxes, and correspondence with pharmacies regarding all operational issues including contract processing, claim investigations, payments, and remittance issues - Process pharmacies, chains, and PSAO's contractual documents, load pharmacy pricing, and document changes for all lines of business - Recruit pharmacy provider agreements with retail pharmacies for varying lines of commercial and Medicaid and Medicare business - Identify, research and correct any errors that may occur when uploading price lists into the PBM to maintain accurate and efficient processing - Assist with the quality assurance processes, ensuring the quality standards are met Education/Experience: Associate's Degree in related field or equivalent experience. 3+ years of related customer service experience required. Pharmacy Benefits Management experience preferred. Proficiency in Microsoft Office applications and experience with proprietary software systems. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Network Development & Contracting USA-California-Fresno Envolve Pharmacy Full-time

Keywords: Centene, Fresno , Pharmacy Credentialing and Contract Representative II, Healthcare , Fresno, California

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