Manager, Licensing & Credentialing

Job description

Manager, Licensing & Credentialing The Manager of Payor Operations will lead the coordination and management of all aspects of PBM/Payor operations and requirements. This individual will be responsible for overseeing the end-to-end processes of payor credentialing, network enrollment, audits, claims issues, and reimbursement resolution. The ideal candidate will have strong expertise in pharmacy benefit management (PBM), pharmacy administration, payor credentialing, payor audits, and claims adjudication. This role is critical to our overall service and offerings to pharmacies. We are looking for a well-rounded member to join our team that is seasoned, experienced and knowledgeable in all aspects of payor operations. This job description is a broad outline of key responsibilities and qualifications, but it is not exhaustive. The Payor Operations Manager may be asked to take on additional tasks as needed to support the organization's overall goals and success. ESSENTIAL FUNCTIONS: Key Responsibilities: Payor Credentialing & Network Enrollment: - Lead and manage the payor credentialing and re-credentialing processes for pharmacies. - Ensure accurate and timely enrollment of pharmacies...