Pharmacy Credentialing/Licensing Analyst

Credentialing Analyst Pharmacy HOURS : General business hours, Monday through Friday. Hybrid -This role requires associates to be in-office 1 - 2 days per week , fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.   Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Credentialing Analyst Pharmacy is responsible for accurate and prompt facility/professional licensing and/or credentialing for health plans and pharmacy benefit managers (PBM) for all pharmacy sites. Primary duties may include, but are not limited to : Manages and maintains pharmacy license tracking tool to advise pharmacy sites and pharmacists of license renewals. Submit new pharmacy license applications and renewals for all pharmacy sites. Maintains confidentiality of all pertinent pharmacy and provider information. Administers credentialing and re-credentialing to ensure compliance with regulatory, accreditation and various managed care plan policies and protocols, standards, and requirements. Develops and fosters collaborative relationships with managed care plans, state agencies and PBM’s to facilitate timely credentialing and re-credentialing of applications. Tracks credentialing and re-credentialing to ensure compliance with time sensitive materials. Maintains all pharmacy site credentialing and re-credentialing files, electronic and paper. Effectively communicates with admission, billing, and clinical teams in a professional manner. Reviews all credentialing policies and procedures for accuracy and completeness. Suggests revisions of policies and procedures when necessary. Completes new Medicaid applications and renewals or revalidations. Medicaid portal maintenance and updates. Maintain NCPDP profile for all pharmacy sites. Certificate of Insurance requests and dissemination to plans or CMS. NPI profile updates (NPPES). URAC, ACHC, NABP support during accreditation renewals. Fraud, Waste and Abuse annual attestation submission to health plans. Additional responsibilities as assigned. Submit Pharmacist in Charge state license changes and renewals.

Requires a H.S. diploma and minimum of 3 years' experience; or any combination of education and experience, which would provide an equivalent background.

Previous experience with pharmacy licensure with state pharmacy boards is strongly preferred. Knowledge of Medicaid, Medicare, Managed care and PBM providers is preferred. Job Level: Non-Management Non-Exempt Workshift: 1st Shift (United States of America) Job Family: PND > Credentialing & Licensing Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we