Network & Provider Compliance Advisor - Express Scripts (Hybrid)
3 weeks ago
Excited to grow your career?
We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply
Our people make all the difference in our success.
Job Summary: This role will assist internal and external business partners in all aspects of Pharmacy operations and Network Compliance including: Credentialing, re-credentialing, contract compliance, provider contracting, network support, validations and day to day pharmacy inquiries. The Advisor role will provide support, strategic direction, and operational oversight, including process improvement, automation, new technology solutions, audit support, client account team support, adherence to internal process and procedures, and compliance with new and existing regulations.
ESSENTIAL FUNCTIONS
- Works closely with our Network providers assisting with day-to-day operations, including but not limited to: application and credentialing support, provider communication, Network participation, Network and Contract Compliance
- Participate in internal and cross functional meetings, assisting internal business partners by supporting client requests and investigating for potential non-compliance.
- Assist with team development, training, and reviewing SOP's/P&P's to ensure processes are accurately documented and followed through day to day business interactions.
- Identify and align business process efficiencies between our teams and cross functional partners
- Ensures network providers adhere to and maintains compliance with state and federal regulations.
- Provides support to client and internal business partners
- Participating in and leading presentations for our Provider Compliance Review Committee
- Ability to research complex issues while also ensuring timely resolution.
Qualifications
- Bachelor's degree strongly desired
- Pharmacy benefit management experience preferred, including familiarity with the regulatory environment and compliance issues (i.e., URAC accreditation maintenance, credentialing, delegation and oversight standards, etc.)
- Strong analytical, planning, problem identification and resolution skills required
- Ability to work in a fast-paced environment and multi-task across multiple deadlines and deliverables, often under uncertain or ambiguous circumstances
- Excellent communication, organizational, and time management skills essential
- Comfortable communicating concerns, questions, and risk at all levels of the organization
- Consistently maintain a positive, helpful, engaged attitude
- Self-starter that can independently support and resolve issues and conflicts with minimal management oversight
- Microsoft Office – Advanced Excel skills, including experience with formulas, data analysis, and/or pivot tables; fluent with Microsoft Access, PowerPoint, Word, etc.
- This role requires the ability to work in person in the St. Louis, MO office at least 3 days a week
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
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