Pharmacy Credentialing Specialist Job at Parkview Health Services, New York, NY

V0NZRnNPbTEvb3liVVZWWlQzV1Z6bzVsNEE9PQ==
  • Parkview Health Services
  • New York, NY

Job Description

Job Description

Position Summary

The Credentialing Specialist is responsible for coordinating and maintaining the credentialing and re-credentialing processes for pharmacists, pharmacy technicians, and contracted providers. This position ensures compliance with regulatory and payer requirements and supports enrollment processes with pharmacy benefit managers (PBMs), health plans, and accreditation bodies (e.g., URAC, ACHC, NABP).

Primary Responsibilities

• Complete timely internal audits that ensure we are in compliance with Medicare regulation and guidelines

• Track and manage Business Associate Agreements internally.

• Support accreditation activity as directed by Director, Compliance.

• Track license expiration dates, DEA registrations, and other critical compliance documents.

• Maintain accurate records in credentialing databases and document management systems.

• Assist with documentation and audits during accreditation, reaccreditation, or payer reviews.

• Submit and track pharmacy enrolment applications with insurers, networks, and state boards.

• Collect, review, and verify licensure, certifications, education, and work history for pharmacists and pharmacy technicians.

• Ensure timely credentialing and re-credentialing of providers and facilities according to payer and regulatory timelines.

• Assist the Director, Compliance with enrollment processes with commercial and government PBMs (e.g., Express Scripts, OptumRx, CVS Caremark, Medicare Part D).

• Create official minutes from Quarterly Quality and Compliance Meetings

• Manage new hires and annual compliance trainings throughout the entire process.

• Other tasks as assigned 

K ey Skills

• Strong understanding of specialty pharmacy workflows and credentialing standards

• Exceptional organizational and time management skills

• High attention to detail and data accuracy

• Accurately interprets written instructions and documents.

• Strong analytical and critical thinking skills.

• Excellent verbal and written communication skills.

• Detail-oriented, organized, and capable of handling confidential data appropriately. Knowledge of pharmacy operations and support systems

• Proficiency in Microsoft Office and credentialing management software

• Knowledge of pharmacy-related compliance requirements (DEA, HIPAA, CMS Part D, 340B).

• Familiarity with PBM and payer enrollment processes

Education/Experience Requirements

• Associate Degree or equivalent work experience.

• 2+ years in pharmacy credentialing, pharmacy operations, or healthcare credentialing.

• Experience working with pharmacy claims data, EMRs, or pharmacy management systems (e.g., PioneerRx, QS/1, Epic)

Job Tags

Work experience placement, Work at office,

Similar Jobs

Greenberg Traurig, LLP

Business Litigation Associate (Junior-Mid Level) (Boston) Job at Greenberg Traurig, LLP

 ...Business Litigation Associate (Junior-Mid Level) Join to apply for the Business...  ...Location: Boston, MA Seniority level: Entry level Employment type: Full-time Job...  ...Administration Job Description The Boston office of Greenberg Traurig seeks a litigation... 

McLaughlin's Energy Services

Seasonal Full-Time Fuel Truck Delivery Driver Job at McLaughlin's Energy Services

 ...Driver to join our team from October through April. Primarily Fuel Oil but also Propane truck driving and delivery. This position is...  ...skills in handling manual transmission, refrigerated trailers, and tankers will be essential for ensuring the proper transportation of fuel... 

IEC - Riverside

Dental Assistant Instructor Job at IEC - Riverside

 ...commitment to helping students build the skills to create a future of which they can be proud. We are currently seeking a Dental Assistant Instructor to join our team at our Riverside Campus . In this position, you will be responsible for delivering quality... 

InVictus

Entry Level Marketing Associate Job at InVictus

 ...Were actively seeking a motivated and enthusiastic Entry-Level Marketing Associate to join our growing team. If you're passionate about...  ...gain hands-on experience in digital marketing, event planning, content creation, and community outreachskills that will set the foundation... 

PPG Industries, Inc.

Aerospace Mechanical/Manufacturing Engineer Job at PPG Industries, Inc.

 ...packaging solutions, collaborating with international subcontractors to troubleshoot and...  ...role reports to the Business Director of Aerospace Packaging, and offers the flexibility of...  ...\n ~ Bachelor's degree in mechanical engineering, manufacturing engineering or related field...