Medicare/Medicaid Credentialing Associate

About Us:

Capsule is rebuilding the $425 billion pharmacy industry from the inside out with an emotionally resonant pharmacy experience that works for everyone, and technology that enables customized outcomes for patients, doctors, hospitals, insurers, and manufacturers. Our team is laser focused on creating the best healthcare experience for our customers, and driving meaningful value and better outcomes for every participant in the healthcare system. Everyone who uses Capsule raves about it - we have 5,000+ five-star app reviews - and we’re expanding quickly to get that experience in the hands of as many people as possible. We’ve raised over $250 million from the best internet and healthcare investors to enable that expansion.

Our values are: everybody needs some looking after sometimes and winning together. People succeed in our culture when they are intensely focused on our customers, energized to accomplish ambitious goals, and push themselves and those around them to be better. We work hard to teach and share our successes to help others be successful. We anticipate our teammates’ needs and communicate early and often, using the input of our peers to operate both fast and right. We have tremendous ambitions and a lot of fun pursuing them — if that excites you, we’d love to have you join us. 

About the Role:

As a Capsule Medicare/Medicaid & Credentialing Associate, you will be on the frontline of Capsule’s mission to build a pharmacy that works for everyone. You will be responsible for establishing network access of Capsule ensuring that Capsule provides a Healthcare experience that works for everyone.  In this role you will report to the Head of Contracting and partner with both the Legal Team and the Licensing & Compliance teams.

• Ensure network access through initial enrollment, and re-enrollment of Medicare, Medicaid, and Fee For Service networks.  
• Ensure NCPDP enrollments and updates.  Maintain online and credentialing requests.
• Apply for all NPI Enrollment and updates with NPPES.
• Ensure all Payer credentialing and recredentialing happens on time and accurately.
• Responsible for daily document review process and back end maintenance of central repository for all payer credentialing, Enrollments, Contract terms, and serve as liaison as data is needed.

About You:

• You take pride in enabling the best work of others on the team. You think ahead to anticipate the needs of your teammates and you give and get all the facts making it easy for others to make decisions.
• You drive results in a way that makes everyone better. You accomplish ambitious objectives while uplifting the team around you. You're a magnet for team members looking to get better and be successful.
• You work hard and want to have fun while you do so. You celebrate wins and remember to enjoy the journey as we build something iconic.
• You can work both fast and right and don't view them as trade-offs. You understand when things require precision and accuracy and where 80% gets you to the desired outcome.
• You thrive on being pushed and challenged. You communicate effectively both in written form and live / on your feet - you are not fazed by tough questions in the moment. 
• You strike the right balance between putting enough work in to share something, but not going off into a corner for weeks at a time to polish something to perfection.
• You operate like an owner and expect others to as well. You take personal responsibility and value personal responsibility in others. 
• You check your ego at the door. You are interested in finding the right answer vs. always having the right answer. 

Requirements 

• Associate degree in Accounting, Healthcare Administration, Business or Law and/or at least two (2) years of pharmacy licensure experience, as well as Medicare and Medicaid enrollment experience as a healthcare provider or working for a pharmacy provider.
• Minimum of one (1) year Experience with Medicare and Medicaid enrollment process.
• Minimum of one (1) year Experience with PBM Credentialing and familiarity with NCPDP and NPPES enrollment.
• Knowledge of BOP & DEA license application requirements and rules.
• Highly accurate and efficient problem solving, organizational and planning skills.  

Capsule is committed to hiring the best team possible to build a pharmacy that works for everyone. We have a diverse set of problems to solve, and believe that we need a diverse set of perspectives to deliver the best possible solutions to those problems. We look for talent from a wide range of backgrounds - including but not limited to - race, age, sexual orientation, gender identity and expression, national origin, religion, disability, and veteran status.