Overview
Pharmacy Director of Credentialing - Specialty Pharmacy
The Pharmacy Director of Credentialing for Specialty Pharmacy oversees the payor credentialing processes and reporting for specialty pharmacies. This role combines strategic leadership with hands-on engagement, ensuring compliance, team efficiency, and positive client outcomes. The director focuses on verifying the qualifications of providers and ensuring compliance with industry standards and regulatory requirements leading to broader network access. Responsible oversight of specialty pharmacy credentialing process, reporting and renewals, direct process improvements that optimize quality and maximize efficiency of pharmacy services consistent with standards of payers. Facilitate the design, development, and implementation of initiatives supporting quality improvement and best practices.
Responsibilities
ESSENTIAL FUNCTIONS: (This document in no way states or implies that these are the only duties to be performed by the employee occupying this position):
Assist the VP to ensure the pharmacies provide optimal services, meet legal and credentialing/certification requirements, and standards of Maxor National Pharmacy Services and its clients.
Travel as required to support current and future clients.
Provide appropriate technical and customer service training for pharmacy staffs.
Identify opportunities for workflow and process improvements to enhance the customer experience.
Ensure compliance with payer credentialing standards, network performance guarantees, reporting, and payer requirements, while identifying and resolving potential onboarding issues via collaboration with diverse stakeholders.
Identify and support opportunities for business growth and development.
Facilitate effective communication with internal and external customers and promote positive client relations.
Work closely with Managed Care Organizations, insurance companies, and other stakeholders to ensure seamless credentialing processes and enrollment.
Monitor changes to credentialing standards and work with the accreditation team to update applicable policies and procedures to ensure compliance with standards.
Train, mentor and coach on credentialing standards by providing focused orientation of applicable SOPs/policies and procedures.
Oversee field audits for compliance with credentialing standards and track/trend issues to develop actionable mitigation strategies.
Participate in Quality Improvement Projects and report progress and credentialing issues.
Promptly report any allegations of impropriety to the Compliance Department.
Comply with Maxor’s Ethical Business Conduct policy and Maxor’s Compliance Program.
Remain free from exclusion under the OIG and SAMS Medicare/Medicaid lists.
Complete required training, as assigned, within the established timeframes.
Must be able to cope with the mental and emotional stress of the position.
Maintain regular attendance in accordance with established policies.
Perform other job-related duties as assigned.
Qualifications
Education: Bachelor’s degree, or Pharmacy Degree, or related field required.
Experience: Five to seven years progressive pharmacy experience in the specialty pharmacy healthcare, insurance or pharmacy benefit management industries required.
KNOWLEDGE, SKILLS, AND ABILITIES:
Strong understanding of credentialing processes, payers, and regulatory requirements.
Knowledge of policies and regulations pertaining to the practice of pharmacy and payor network eligibility in multiple jurisdictions.
Knowledge of related credentialing and certification requirements in multiple pharmacy practice sites.
Strong customer service, leadership, and supervisory skills.
Ability to work effectively with a multi-disciplinary team.
Effective written and verbal communication skills.
Skill in the use of personal computers and related software applications.
WE OFFER
At Maxor, we foster a diverse and progressive culture that promotes a work-from-home model and a "dress-for-your-day" approach to work attire. Our team-oriented environment encourages collaboration and innovation.
We offer highly competitive compensation and comprehensive health benefits including:
- Comprehensive mental health and wellbeing resources
- Nationwide Blue Cross Blue Shield PPO with employee-friendly plan design, including a $850 individual annual medical deductible and $25 office visit copays, with low biweekly premiums
- Company-paid basic life/AD&D, short-term and long-term disability insurance
- Rx, dental, vision, other voluntary benefits, and FSA
- Employer-matched 401k Plan
- Industry-leading PTO plan
- And more!
Apply today at: https://www.maxor.com/careers/
Maxor is an EOE, including disability/vets
