Credentialing Representative

Genesis10 is seeking a Credentialing Representative for a contract with our client in Eagan, MN. 100% Remote.

Job Description:

Summary: The Credentialing Representative is responsible for supporting the integrity of client's pharmacy network by performing basic credentialing reviews of pharmacy providers to ensure adherence to client's policies, procedures, and regulatory requirements (e.g. CMS, , URAC, and state regulations)

Key Responsibilities:

• Evaluate relevant data to process re-credentialing of existing pharmacy providers in client's network continue to adhere to client's policies, procedures, and regulatory requirements
• Summarize findings in support of recommended decisions regarding the pharmacy providers continued participation in client's network; prepare materials for review by leadership and/or client's Credentialing Committee
• Research potential credentialing issues and partner with internal and external entities to ensure submissions are complete and accurate; this includes collecting information from the State Board of Pharmacy and other regulatory agencies
• Maintain up to date licensing information and input research information into the credentialing application
• Identify potential risks to client's pharmacy network by applying knowledge of credentialing standards, pharmacy practice, and state and federal regulations; communicate suspected FWA to leadership
• Support credentialing projects and process improvement initiatives
• Other duties as assigned

Required Basic Qualifications:

• Associate's degree in Business, Health Information Management or related area of study, or equivalent * combination of education and/or relevant work experience; HS diploma or GED is required
• 1 year of work experience in customer service to include at least 6 months in credentialing,
• auditing, investigations, accreditation, compliance, or highly regulated function
• Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

• Detail oriented and ability to work with a high degree of accuracy
• Excellent organizational and communication skills
• Demonstrated ability to think critically and problem solve
• Enhanced organizational skills with the ability to work on multiple tasks simultaneously
• Intermediate proficiency within MS Office such as Access, Excel, PowerPoint, and Word

Preferred Qualifications

• Demonstrated ability to complete projects within established timeframes
• PBM or pharmacy experience
• Certified Provider Credentialing Specialist (CPCS)
• Certified Professional medical Services Management (CPMSM)
• National Pharmacy Technician Certification (CPhT)

Minimum Physical Job Requirements

• Constantly required to sit, use hands to handle or feel, talk and hear
• Frequently required to reach with hands and arms
• Occasionally required to stand, walk and stoop, kneel, and crouch
• Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
• Specific vision abilities required by this job include close vision, distance vision, color vision,peripheral

Compensation:

Hourly W2 pay rate $

We have access to additional contract, contract-to-hire, and direct hire positions with various rate ranges.

If you have the described qualifications and are interested in this exciting opportunity, apply today

Ranked a Top Staffing Firm in the U.S. by Staffing Industry Analysts for six consecutive years, Genesis10 puts thousands of consultants and employees to work across the United States every year in contract, contract-for-hire, and permanent placement roles. With more than 300 active clients, Genesis10 provides access to many of the Fortune 100 firms and a variety of mid-market organizations across the full spectrum of industry verticals.

For contract roles, Genesis10 offers the benefits listed below. If this is a perm-placement opportunity, our recruiter can talk you through the unique benefits offered for that particular client. Benefits of Working with Genesis10:

Access to hundreds of clients, most who have been working with Genesis10 for 5-20+ years.

The opportunity to have a career-home in Genesis10; many of our consultants have been working exclusively with Genesis10 for years.

Access to an experienced, caring recruiting team (more than 7 years of experience, on average.)

Behavioral Health Platform

Medical, Dental, Vision

Health Savings Account

Voluntary Hospital Indemnity (Critical Illness & Accident)

Voluntary Term Life Insurance

401K

Sick Pay (for applicable states/municipalities)

Commuter Benefits (Dallas, NYC, SF)

Remote opportunities available

For multiple years running, Genesis10 has been recognized as a Top Staffing Firm in the U.S., as a Best Company for Work-Life Balance, as a Best Company for Career Growth, for Diversity, and for Leadership, amongst others. To learn more and to view all our available career opportunities, please visit us at our website.

Genesis10 is an Equal Opportunity Employer. Candidates will receive consideration without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Genesis10 is an Equal Opportunity Employer/Minorities/Female/Disabled/Veteran

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