Credentialing Specialist I, Amazon Pharmacy
About the position Responsibilities ā¢ Streamline Payer & Medicaid credentialing and cross-team processes by introducing improved controls, enhancing operational efficiency, and successfully delivering projects.
ā¢ Manage upstream dependencies (Payer Relations, Compliance, Ops Compliance, Tax, Legal, Global Risk, Ops & Biz Tech), and downstream dependencies (FinOps, Reimbursement, Audit, Accounting, B2B, and Quality) to ensure timely & accurate collection, validation, and ultimately dissemination of information to external customers.
ā¢ Develop tracking mechanisms and implement risk management policies by partnering with Legal & Compliance stakeholder groups to proactively minimize identified risks and reactively address operational gaps.
ā¢ Improve existing processes iteratively and introduce new initiatives to help drive down risk while meeting compliance and policy requirements as it pertains to financial penalties, customer accessibility, insurance coverage of new FCs, electronic remittance, and payments.
ā¢ Handle day-to-day stakeholder inquiries, route payer correspondence to the relevant owners, and collaborate with partner teams to drive projects, while creating long-term scalable solutions that improve stakeholder accountability.
ā¢ Evaluate and address potential risks to the company with upstream and downstream stakeholder groups, including network termination, financial penalties, operational blockers, and payer compliance risks.
ā¢ Ensure compliance with relevant laws and regulations through collaboration with cross-functional teams.
ā¢ Work backwards with key stakeholders in developing proactive mechanisms in order to evaluate operational gaps and scope out new business initiatives, considering the potential risks and rewards. ā¢ Provide expert guidance and support to team members on risk management escalation and issues.
ā¢ Stay informed of industry developments, changing regulations, and emerging risks in the pharmacy sector. Requirements ā¢ 3+ years of experience managing financials/projects, Bachelor's degree. ā¢ Experience in owning and navigating financial metrics in a disrupted industry.
ā¢ Ability to understand cross-function interdependence among partner teams. ā¢ Advanced proficiency in MS Excel, Word, document writing. ā¢ Basic understanding of the Pharmaceutical industry including PBMs, manufacturers, distributors, providers, and payers.
ā¢ Excellent communication/interpersonal skills, analytical and problem-solving skills. Nice-to-haves ā¢ Credentialing and/or Risk Management experience. ā¢ CPCS certification from NAMMS or Certified Risk Manager (CRM) is a plus.
ā¢ Strong quantitative skills and ability to dive deep into data to distill and communicate root cause. ā¢ Strong ownership with ability to toggle between tactical and strategic activities. ā¢ Manage and lead cross-functional meetings.
ā¢ Experience working for or with PBMs, manufacturers, distributors, or providers. Benefits ā¢ Equity, sign-on payments, and other forms of compensation may be provided as part of a total compensation package. ā¢ Full range of medical, financial, and/or other benefits.
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ā¢ Manage upstream dependencies (Payer Relations, Compliance, Ops Compliance, Tax, Legal, Global Risk, Ops & Biz Tech), and downstream dependencies (FinOps, Reimbursement, Audit, Accounting, B2B, and Quality) to ensure timely & accurate collection, validation, and ultimately dissemination of information to external customers.
ā¢ Develop tracking mechanisms and implement risk management policies by partnering with Legal & Compliance stakeholder groups to proactively minimize identified risks and reactively address operational gaps.
ā¢ Improve existing processes iteratively and introduce new initiatives to help drive down risk while meeting compliance and policy requirements as it pertains to financial penalties, customer accessibility, insurance coverage of new FCs, electronic remittance, and payments.
ā¢ Handle day-to-day stakeholder inquiries, route payer correspondence to the relevant owners, and collaborate with partner teams to drive projects, while creating long-term scalable solutions that improve stakeholder accountability.
ā¢ Evaluate and address potential risks to the company with upstream and downstream stakeholder groups, including network termination, financial penalties, operational blockers, and payer compliance risks.
ā¢ Ensure compliance with relevant laws and regulations through collaboration with cross-functional teams.
ā¢ Work backwards with key stakeholders in developing proactive mechanisms in order to evaluate operational gaps and scope out new business initiatives, considering the potential risks and rewards. ā¢ Provide expert guidance and support to team members on risk management escalation and issues.
ā¢ Stay informed of industry developments, changing regulations, and emerging risks in the pharmacy sector. Requirements ā¢ 3+ years of experience managing financials/projects, Bachelor's degree. ā¢ Experience in owning and navigating financial metrics in a disrupted industry.
ā¢ Ability to understand cross-function interdependence among partner teams. ā¢ Advanced proficiency in MS Excel, Word, document writing. ā¢ Basic understanding of the Pharmaceutical industry including PBMs, manufacturers, distributors, providers, and payers.
ā¢ Excellent communication/interpersonal skills, analytical and problem-solving skills. Nice-to-haves ā¢ Credentialing and/or Risk Management experience. ā¢ CPCS certification from NAMMS or Certified Risk Manager (CRM) is a plus.
ā¢ Strong quantitative skills and ability to dive deep into data to distill and communicate root cause. ā¢ Strong ownership with ability to toggle between tactical and strategic activities. ā¢ Manage and lead cross-functional meetings.
ā¢ Experience working for or with PBMs, manufacturers, distributors, or providers. Benefits ā¢ Equity, sign-on payments, and other forms of compensation may be provided as part of a total compensation package. ā¢ Full range of medical, financial, and/or other benefits.
Apply Now
Apply Now