Credentialing Analyst- Express Scripts

POSITION SUMMARY

Responsible for credentialing all new network providers to ensure Express Scripts’ standards are met before allowing to contract in Express-Scripts’ Retail Provider Network.  Assuring all network providers currently contracted with Express Scripts are complying with the terms and conditions of their Provider Agreement by conducting re-credentialing and performing exclusion checks with OIG, SAM and other government agencies. Document responses in database and conduct follow-up activities to ensure response. Responsible for providing necessary documentation and reporting to the client. Work cross-functionally with other areas of Provider Relations to help maintain up-to-date pharmacy and network pharmacy network information. Process incoming provider agreements and assist with special projects as needed.

ESSENTIAL FUNCTIONS

• Process new pharmacy applications/credentials and issue re-credential request to all existing independent pharmacies.
• Perform exclusion checks on OIG/SAM, verify license status against State Board of pharmacy websites, review background checks performed by third party vendor, and review any sanctions against licenses.
• Document responses and conduct follow up activities.
• Maintain organized electronic files of all documentation returned as part of the credentialing/re-credentialing process.
• Process incoming provider agreements and exhibits.
• Create/send request for provider agreements and exhibits to NC&M.
• Generate Credentialing/Re-credential reports as needed for specific clients.
• Perform special projects as needed.
• Work cross-functionally with other areas of Provider Relations to help maintain up-to-date pharmacy and network information by alerting NTWK Support of ownership changes which require re-contracting and Network Management of changes in pharmacy demographic information (address, phone, etc) also, backing Pharmacy Ops on the phones as well as calling campaigns.

QUALIFICATIONS

• Bachelor’s Degree or equivalent work experience.
• Up to 2 years PBM experience or six to eight years of relevant work experience.
• Pharmacy Tech license preferred.
• Working PC knowledge including Microsoft Office and Internet required.
• Experience with Access strongly preferred.
• Strong attention to detail.
• Ability to work in a fast-paced environment/multi-task.
• Excellent communication, organizational and time management skills essential.
• Ability to work well with all levels of internal and external contacts required.
• Ability to work with minimum management oversight.
• Professional demeanor at all times.
• Strong complex problem solving skills.

ABOUT THE DEPARTMENT

Our Pharma & Retail Relations team plays a key role in keeping us at the forefront of healthcare evolution. Team members are tasked with overseeing partnerships with Express Scripts’ key supplier groups, including brand and generic pharmaceutical manufacturers, retail pharmacies and drug wholesalers. Successfully maintaining these relationships allows our 83+ million patients to have access to the medicine they need at a price they can afford.

ABOUT EXPRESS SCRIPTS

At Express Scripts, we dare to imagine a better health care system, and we’re driven to make it happen. Where some see obstacles, we see possibilities. We’re challengers, difference-makers and opportunity-seekers, united with our partners in pursuit of a simpler, more sustainable system and better health for all.

We have always acted first to take on the toughest challenges. We uniquely partner across the health care ecosystem to uncover opportunities, take action, advance health care and deliver better outcomes – like no one else can. We believe health care can do more. We are Champions For BetterSM.

Express Scripts, part of Cigna Corporation, unlocks new value in pharmacy, medical and beyond to further total health for all.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require an accommodation based on your physical or mental disability please email: SeeYourself@cigna.com. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.