Senior Credentialing Specialist
Job Description:
AlignRx is a Public Benefit LLC (PBLLC)—a for-profit limited liability company that is intended to produce a public benefit and to operate in a sustainable manner. We are the only PSAO to establish itself as this type of legal entity, as we are deeply committed to promoting the interests of community pharmacies. You can count on us to be transparent, accountable, and passionate.
As an independently owned PSAO, we want community pharmacy owners to have maximum flexibility in their buy-side choices so they can maintain control over their business. AlignRx does not require pharmacy owners to purchase from a specific wholesaler or buying group. This benefit is just one more reason that community pharmacies experience peace of mind knowing our interests are in sync with theirs.
Our mission is to support community pharmacy by offering innovative products and services that are best in class and designed to promote the pharmacies we serve as essential healthcare providers, resulting in improved patient care and outcomes.
Job Summary:
The Senior Credentialing Specialist plays a critical role in facilitating the enrollment process for pharmacies joining the AlignRx pharmacy network. This position is responsible for ensuring timely and accurate credentialing and enrollment, which includes document collection, primary source verification, and contract execution. This position requires exceptional communication and organizational skills.
Essential Job Functions:
• Perform initial enrollment requirements, ensuring compliance with department policies, including:
• Verify business and ownership structure.
• Conduct credit history (Clear and Experian).
• Performing primary source verification of licensure, certification, and insurance coverage.
• Verify and collect required documents, ensuring they are current, active, and accurate, and resolve any discrepancies in a timely manner.
• Conduct thorough checks to ensure business owners and employees are not listed on the OIG/SAM Exclusion Report.
• Identify red flags (e.g., credit issues, OIG/SAM) through the enrollment process, alerting the Manager, Enrollment via the management review process.
• Ensure proper documents are selected during the enrollment process, to include:
• Data Authorization.
• 835 File Request (if applicable).
• State Medicaid (if applicable).
• PSAO Agreement.
• Bank Authorization.
• NCPDP URF.
• Coordinate the initial affiliation process between NCPDP, the PBMs and AlignRx, ensuring efficient and timely onboarding of pharmacies.
• Notify pharmacy owners of their enrollment status via email and phone throughout the enrollment process.
• Verify and confirm the selection of contracts tied to the services the pharmacy has enrolled in, while ensuring these services are correctly recorded in PDMS.
• Ensure timely connection of pharmacy through NCPDP by the 15th of each month.
• Distribute the welcome letter via email to the pharmacy upon successful enrollment.
• Notify internal departments via department Inboxes (Finance, Sales, and Data Integrity) regarding newly onboarded pharmacies and the services they have enrolled in (e.g., PSAO, Silver, Data Agg, eRecon, RxProtect).
• Implement all job duties in accordance with the Network Management-defined policy and procedures.
• Document call and work activity in the Pharmacy Data Management System (PDMS) and review the Daily Notes report to ensure follow-up and resolution.
• Participate in the department phone queue, addressing pharmacy member inquiries.
• Maintain comprehensive knowledge of AlignRx programs and services; effectively utilize and resources to accurately address pharmacy members’ inquiries during the enrollment process.
Additional Responsibilities:
• Perform other duties and projects as required by management.
Minimum Qualifications for Consideration:
• High school diploma.
• Five or more years’ experience as a pharmacy technician in a retail pharmacy environment or with a PSAO, OR;
• Five or more years’ experience in provider enrollment and/or credentialing.
Knowledge, Skills, and Abilities:
• Excellent verbal and written communication skills.
• Good interpersonal skills: able to work and communicate effectively with all levels of co-workers, clients, and other external contacts.
• Strong organizational and time management skills.
• Dependable with good attendance.
• Adherence to strict deadlines, timelines, and schedules.
Apply tot his job
Apply To this Job
AlignRx is a Public Benefit LLC (PBLLC)—a for-profit limited liability company that is intended to produce a public benefit and to operate in a sustainable manner. We are the only PSAO to establish itself as this type of legal entity, as we are deeply committed to promoting the interests of community pharmacies. You can count on us to be transparent, accountable, and passionate.
As an independently owned PSAO, we want community pharmacy owners to have maximum flexibility in their buy-side choices so they can maintain control over their business. AlignRx does not require pharmacy owners to purchase from a specific wholesaler or buying group. This benefit is just one more reason that community pharmacies experience peace of mind knowing our interests are in sync with theirs.
Our mission is to support community pharmacy by offering innovative products and services that are best in class and designed to promote the pharmacies we serve as essential healthcare providers, resulting in improved patient care and outcomes.
Job Summary:
The Senior Credentialing Specialist plays a critical role in facilitating the enrollment process for pharmacies joining the AlignRx pharmacy network. This position is responsible for ensuring timely and accurate credentialing and enrollment, which includes document collection, primary source verification, and contract execution. This position requires exceptional communication and organizational skills.
Essential Job Functions:
• Perform initial enrollment requirements, ensuring compliance with department policies, including:
• Verify business and ownership structure.
• Conduct credit history (Clear and Experian).
• Performing primary source verification of licensure, certification, and insurance coverage.
• Verify and collect required documents, ensuring they are current, active, and accurate, and resolve any discrepancies in a timely manner.
• Conduct thorough checks to ensure business owners and employees are not listed on the OIG/SAM Exclusion Report.
• Identify red flags (e.g., credit issues, OIG/SAM) through the enrollment process, alerting the Manager, Enrollment via the management review process.
• Ensure proper documents are selected during the enrollment process, to include:
• Data Authorization.
• 835 File Request (if applicable).
• State Medicaid (if applicable).
• PSAO Agreement.
• Bank Authorization.
• NCPDP URF.
• Coordinate the initial affiliation process between NCPDP, the PBMs and AlignRx, ensuring efficient and timely onboarding of pharmacies.
• Notify pharmacy owners of their enrollment status via email and phone throughout the enrollment process.
• Verify and confirm the selection of contracts tied to the services the pharmacy has enrolled in, while ensuring these services are correctly recorded in PDMS.
• Ensure timely connection of pharmacy through NCPDP by the 15th of each month.
• Distribute the welcome letter via email to the pharmacy upon successful enrollment.
• Notify internal departments via department Inboxes (Finance, Sales, and Data Integrity) regarding newly onboarded pharmacies and the services they have enrolled in (e.g., PSAO, Silver, Data Agg, eRecon, RxProtect).
• Implement all job duties in accordance with the Network Management-defined policy and procedures.
• Document call and work activity in the Pharmacy Data Management System (PDMS) and review the Daily Notes report to ensure follow-up and resolution.
• Participate in the department phone queue, addressing pharmacy member inquiries.
• Maintain comprehensive knowledge of AlignRx programs and services; effectively utilize and resources to accurately address pharmacy members’ inquiries during the enrollment process.
Additional Responsibilities:
• Perform other duties and projects as required by management.
Minimum Qualifications for Consideration:
• High school diploma.
• Five or more years’ experience as a pharmacy technician in a retail pharmacy environment or with a PSAO, OR;
• Five or more years’ experience in provider enrollment and/or credentialing.
Knowledge, Skills, and Abilities:
• Excellent verbal and written communication skills.
• Good interpersonal skills: able to work and communicate effectively with all levels of co-workers, clients, and other external contacts.
• Strong organizational and time management skills.
• Dependable with good attendance.
• Adherence to strict deadlines, timelines, and schedules.
Apply tot his job
Apply To this Job