Credentialing Specialist

Description:The Credentialing Representative is responsible for supporting the integrity of pharmacy network by performing basic credentialing reviews of pharmacy providers to ensure adherence to policies, procedures, and regulatory requirements (e.g. CMS, , URAC, and state regulations).Evaluate relevant data to process re-credentialing of existing pharmacy providers in network continue to adhere to policies, procedures, and regulatory requirements Summarize findings in support of recommended Decisions regarding the pharmacy providers continued participation in network; prepare materials for review by leadership and/or Credentialing Committee Research potential credentialing issues and partner with internal and external entities to ensure submissions are complete and accurate; this includes collecting information from the State Board of Pharmacy and other regulatory agencies Maintain up to date licensing information and input research information into the credentialing application Support credentialing projects and process improvement initiativesQualifications:3+ years of professional customer support in a health insurance environmentMedical Term experienceHealth Insurance experienceShift:Monday-Friday, 8am-5pm CSTAbout TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.