Be Part of an Extraordinary Team

BioPlus Specialty Pharmacy is now part of CarelonRx (formerly IngenioRx), and a proud member of the Elevance Health family of companies. Together, CarelonRx and BioPlus offer consumers and providers an unparalleled level of service that’s easy and focused on whole health. Through our distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer’s treatment journey.

Build the Possibilities. Make an Extraordinary Impact.

Location - Monday – Friday ONSITE at 380 Northlake Blvd, Altamonte Springs, FL 32701. Candidates must reside within 50 miles or 1-hour commute each way of posted office location.

The Credentialing Analyst Pharmacy is responsible for accurate and prompt credentialing for health plans and pharmacy benefit managers (PBM) for all pharmacy sites.

How you will make an impact:

Primary duties may include, but are not limited to:

• Acts as a troubleshooter in resolving payor departmental issues related to credentialing.

• Manages and maintains pharmacy license tracking tool to advise pharmacy sites and pharmacists of license renewals.

• 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.

• Medicaid administrator user access for billing.

• Pull Medicaid remits for billing team upon request if portal access is limited.

• Manage PBM credentialing requests and maintenance.

• Medicare (PECOS) processing for all pharmacy sites.

• 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.

• Manage pharmacy Continuing Education Units for RFP’s. Pull and maintain credentialing documents for payor applications.

• Knowledge of Medicaid, Medicare, Managedcare and PBM providers.

• Additional responsibilities as assigned.

• Submit new pharmacy license applications and renewals for all pharmacy sites.

• Submit Pharmacist in Charge state license changes and renewals.

Minimum Requirements:

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

Preferred Skills, Capabilities and Experiences:

• Strongly preferred certified Provider Credentialing Specialist and college course work.