Credentialing Specialist I, Amazon Pharmacy Job at PillPack, LLC, Austin, TX

TStZdGdPVFFkU2I4RnFHdFNvNXVDMTBQ
  • PillPack, LLC
  • Austin, TX

Job Description

DESCRIPTION

Amazon Pharmacy is committed to build the future of pharmacy by offering technology solutions that drive and enable us to be the world’s most customer centric pharmacy option. The Payer Operations team is seeking an L4 Risk Manager to develop and execute foundational reporting, risk analysis, and tactical requests from internal stakeholders. This position will be heavily involved in cross-functional activity and external PBM & State Medicaid communications. This individual will build and scale operational processes for pharmacy credentialing and launches while ensuring alignment with 3P risks and regulatory requirements. Payers represent 88%+ of US prescription spend and a clean and organized input filing is a requisite for AP’s success. This role is critical to AP as it is the primary mechanism to maintain payer credentials and reduce unintended network impacts. The ideal candidate will have a broad understanding of the healthcare sector with strong organizational skills, an analytical toolset to deep dive, create efficiencies, manage risk tolerances, and optimize existing policies.

Key job responsibilities
• Streamline Payer & Medicaid credentialing and cross-team processes by introducing improved controls, enhancing operational efficiency, and successfully delivering projects
• Manage upstream dependencies (Payer Relations, Compliance, Ops Compliance, Tax, Legal, Global Risk, Ops & Biz Tech), and downstream dependencies (FinOps, Reimbursement, Audit, Accounting, B2B, and Quality) to ensure timely & accurate collection, validation, and ultimately dissemination of information to external customers.
• Develop tracking mechanisms and implement risk management policies by partnering with Legal & Compliance stakeholder groups to proactively minimize identified risks and reactively address operational gaps.
• Improve existing processes iteratively and introduce new initiatives to help drive down risk while meeting compliance and policy requirements as it pertains to financial penalties, customer accessibility, insurance coverage of new FCs, electronic remittance, and payments.
• Handle day-to-day stakeholder inquiries, route payer correspondence to the relevant owners, and collaborate with partner teams to drive projects, while creating long-term scalable solutions that improve stakeholder accountability.
• Evaluate and address potential risks to the company with upstream and downstream stakeholder groups, including network termination, financial penalties, operational blockers, and payer compliance risks.
• Ensure compliance with relevant laws and regulations through collaboration with cross-functional teams.
• Work backwards with key stakeholders in developing proactive mechanisms in order to evaluate operational gaps and scope out new business initiatives, considering the potential risks and rewards.
• Provide expert guidance and support to team members on risk management escalation and issues.
• Stay informed of industry developments, changing regulations, and emerging risks in the pharmacy sector.

BASIC QUALIFICATIONS

• 3+ years of experience managing financials/projects, Bachelor’s degree.
• Experience in owning and navigating financial metrics in a disrupted industry.
• Ability to understand cross-function interdependence among partner teams.
• Advanced proficiency in MS Excel, Word, document writing.
• Basic understanding of the Pharmaceutical industry including PBMs, manufacturers, distributors, providers, and payers.
• Excellent communication/interpersonal skills, analytical and problem-solving skills.

Job Tags

Full time,

Similar Jobs

Always Best Care Senior Services - Seattle / Tacoma

HCA/CNA's Needed ASAP Job at Always Best Care Senior Services - Seattle / Tacoma

 ...hour based on location, experience, and certifications* Full-time and Part-time work available.* Weekly pay (paid every Friday)* Paid...  ...to Supervisor REQUIREMENTS* Must be Certified as a CNA (Nursing Assistant Certification or HCA (Home Care Aide) in the... 

Elegant Fireside and Patio

Helpers Job at Elegant Fireside and Patio

 ...tools.~MUST HAVE COMMON SENSE!~Be on time. Every time.~Most importantly you must be a team player, and a good team mate!Helpers work from 8:30 am until the jobs are done. Oct-Feb is a 6 day work week with paid overtime and bonuses. Summer months are typical 2... 

China Global Connections

History Teacher Job at China Global Connections

We are looking for a History Teacher for an international High school based in Shenzhen. This is a full-time position starting from the upcoming academic year in August 2025. About the schoolThe international school, situated in the Nanshan Zone, is spread over an area... 

Nothing Bundt Cakes

Cake Decorator Job at Nothing Bundt Cakes

 ...JOY is the JOB! Be sure you are applying to work at this location: Nothing Bundt Cakes - Cypress, 9822 Fry Rd, STE 170, Cypress, TX 77433 At Nothing Bundt Cakes, the Cake Decorator - Froster puts the sugar on top and makes every moment extra sweet. Youll put... 

HavocAI

Distributed Communications Network Engineer Job at HavocAI

 ...dynamic environment where collaboration and idea sharing are a way of life. We are looking for a skilled Distributed Communications Network Engineer who will participate on all product stages from research and development to design and manufacture, through to installation...