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Payor Credentialing Assistant

2 months ago

Laguna Woods, United States AmeriPharma Full time

About AmeriPharma

AmeriPharma is a rapidly growing healthcare company where you will have the opportunity to contribute to our joint success on a daily basis. We value new ideas, creativity, and productivity. We like people who are passionate about their roles and people who like to grow and change as the company evolves.

AmeriPharma's Benefits

  • Full benefits package including medical, dental, vision, life that fits your lifestyle and goals
  • Great pay and general compensation structures
  • Employee assistance program to assist with mental health, legal questions, financial counseling etc.
  • Comprehensive PTO and sick leave options
  • 401k program
  • Plenty of opportunities for growth and advancement
  • Company sponsored outings and team-building events
  • Casual Fridays
Job Summary

Reporting to the Quality Compliance Manager, the Payor Credentialing Assistant supports the Specialist(s) in ensuring providers are credentialed, contracted, and active with payors in a timely manner. This position serves as a liaison between various departments and external associates to facilitate effective communication and support organizational standards. Responsibilities require a knowledge of payor-provider relationships, contracting, provider enrollment, and credentialing.

Schedule Details

In-Person (Laguna Hills, Ca)

Monday-Friday 8:00am-4:30pm

Duties and Responsibilities
  • Assists in gathering and maintaining all contracting, enrollment and credentialing documentation and obtaining
    missing or incomplete information to accurately fulfill external provider enrollment and credentialing requests
    to meet critical deadlines
  • Assists the Specialists in reviewing and maintaining contracts with payors
  • Creates, maintains, and organizes payors agreement provisions within the pharmacies database
  • Stores, updates and maintains payors education materials in the shared folders
  • Assists in monitoring compliance with payors contractual obligations, and regulations
  • Updates the team about changes in the healthcare industry, payer policies, and regulations
  • Ensure accurate pharmacies information is updated promptly
  • Assists in departmental responsibilities and collaborates with team members to achieve short- and long-term
    goals
  • Utilizes online systems, written correspondence, telephone inquiries, and reference guides for follow-ups
  • Assists the Specialist(s) in solving any problems that arise in the credentialing process
  • Assists with other duties to support the process and the company's core values
Required Qualification
  • Excellent verbal and written communication skills
  • Excellent interpersonal and customer service skills
  • Excellent organizational skills and attention to detail
  • Ability to function well in a high-paced and at times stressful environment
  • Ability to work in a team environment providing support to multiple positions
  • Proficient with Google Suite, Microsoft Office Suite
Education and Experience Requirements
  • High school diploma or equivalent
  • At least two years' experience in credentialing/enrollment within the healthcare setting
  • Knowledgeable in credentialing processes and procedures for payors across multiple states/regions
  • Familiarity with PAVE (Provider Application and validation for Enrollment) & PECOS (Provider Enrollment Chain
    and Ownership System)
  • Knowledge of state, federal, and accreditation entity regulations related to payor credentialing


AmeriPharma's Mission Statement

Our goal is to achieve superior clinical and economic outcomes while maintaining the utmost compassion and care for our patients. It is our joint and individual responsibility daily to demonstrate to outpatients, prescribers, colleagues, and others that We Care

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is continuously required to sit and talk or hear. The employee is occasionally required to stand; walk; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and stoop, kneel, crouch or crawl. The employee must regularly lift and/or move up to 20 pounds and occasionally lift/or move up to 30 pounds. Specific vision abilities required by this job include close vision, peripheral vision, depth perception and the ability to adjust focus.

EEO Statement

The above statements are intended to describe the work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required. The duties and responsibilities of this position are subject to change and other duties may be assigned or removed at any time. AmeriPharma values diversity in its workforce and is proud to be an AAP/EEO employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, sexual orientation, gender identity, national origin, age, protected veteran status, or based on disability or any other legally protected class.