Credentialing Specialist
Mendota Heights , Minnesota
November 19, 2017

A large pharmaceutical management company in Mendota Heights is hiring for a Credentialing Specialist - YOU DON'T NEED DIRECT CREDENTIALING EXPERIENCE TO BE CONSIDERED FOR THIS ROLE! One year of healthcare experience and a bachelor's degree is preferred! This position is responsible for activities associated with the credentialing and re-credentialing of #146; pharmacies. This position will follow-up on escalated outstanding questions by pharmacy providers. This position is also responsible for supporting the compliance of Fraud, Waste, and Abuse (FWA) training by contracted pharmacy providers. This position will coordinate responses to external and internal Audit requests. Job Responsibilities: Reviews and processes credentialing applications based on guidelines established by the Credentialing Committee, complying with state and federal laws, and URAC, verifying information submitted by pharmacy providers. Enters licensing and insurance information into license tracking database. Researches potential credentialing issues, including collecting information from State Board of Pharmacy and other regulatory bodies. Processes Ownership Disclosure Attestations as required for Medicaid programs. Includes verifying all information is provided and comparing data to OIG Exclusions database. Coordinates work flow and provides back-up support for credentialing and re-credentialing activities Resolves escalated credentialing issues and communicates with pharmacies to resolve or correct issues If you meet these requirements, please send your resume to with "Credentialing Specialist" in the subject line. Thank you!

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Founded in 1948, Robert Half (NYSE: RHI) is the world's first and largest specialized staffing services firm.

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