• Credentialing Representative

    Job Location US-MI-Detroit
    Job ID
    Business Line
  • Overview

    Who we are:

    MeridianRx is a full-service Pharmacy Benefit Manager (PBM) committed to driving down costs and elevating quality. Our clients experience better quality outcomes, thanks to effective clinical support, patient education, and specialty pharmacy programs.

    We work with a diverse range of clients, from members to healthcare providers to plan administrators. MeridianRx services clients across the country and our network continues to grow.

    Our employees work hard, play hard, and give back. MeridianRx employees enjoy: Happy hours, special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.



    A Day in the Life of a Credentialing Representative:

    This position is responsible for facilitating the contracting and credentialing of Network Pharmacies under the direction of the Manager of MRx Network Management. The role of the Credentialing Representative is to establish and maintain the proper credentialing and contracting for all potential pharmacies. The primary focus is to ensure that credentialing standards and implementation of pharmacy agreements meet organization standards. The position helps to develop and facilitate network oversight and audit requirements that are necessary to meet the regulatory, management, quality and clinical data needs. As necessary the position will also be responsible for providing operational support for the Network Management department.


    • Assist with, contracting process for all potential pharmacies, including prospecting, basic negotiation, credentialing and development of orientation materials if necessary.
    • Assist in the collection all Pharmacy signed contracts, applications and necessary credentialing information ensuring MeridianRx credentialing standards are maintained.
    • Ensure compliance with all company, state and federal rules and regulations
    • Manage Network pharmacy information on intranet site
    • Ensure proper credentialing and implementation of pharmacy provider's agreements meet organization standards.
    • Ensure proper accuracy and maintenance of the MeridianRx pharmacy database system.
    • Monitor application documentation for fraud, waste and abuse, investigate adverse findings and report any questionable items to the Manager of Network Management.
    • Maintain internal reporting and trending, including but not limited to network access and expansion, fraud waste and abuse findings, and other necessary reports as needed
    • Assist in streamlining and improving department processes.
    • Maintain filing and documentation tracking system for all credentialing information.
    • Schedule and perform necessary site-visits and delegated credentialing audits. 
    • Maintain accurate tracking of all audit events per PSAO. 
    • Support the Manager of Network Management in preparing for Credentialing.
    • Educating Network Pharmacies on MeridianRx provider policies and procedures
    • Assist in the completion of Request for Information/Proposals as needed
    • Building key customer and provider relationships to maintain a good position in the market.
    • Following up with clients continuously, responding to client enquiries through calls, email, or letters.
    • Provide solution to client problems and resolving consumer complaints.
    • Assist in special projects assigned by the Manager of Network Management.
    • Ability to fill in for the Manager of Network Management at meetings/committees, where appropriate
    • Maintain knowledge of the credentialing requirements of all national and State agencies, including National Committee for Quality Assurance (NCQA), URAC, or general accreditation and support the Manager of Network Management in fulfilling contracting and credentialing expectations


    What you can bring to MeridianRx:

    • High school diploma or GED is required. 
    • Pursuit of a Bachelor's degree or Fellow designation from the Academy of Healthcare Management is preferred. 
    • One to three years of credentialing experience in a managed care setting, including processing credentialing and credentialing files is preferred 
    • At least one year experience in a professional office environment is preferred. 
    • Thorough knowledge of MRx's mission and operational structure. 
    • Thorough knowledge of the contracting and credentialing process. 
    • Thorough knowledge of Pharmacy Reimbursement terms and methodologies.
    • Basic knowledge of pharmacy operations. 
    • Basic knowledge of medical and pharmaceutical terminology. 
    • Knowledge and/or experience in work teams.

    What MeridianRx can offer you:

    • Healthcare benefits that include a variety of plans, which are effective on the first day of employment for our new full-time team members. 
    • Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
    • 401k matching that is above the national average. 
    • Full-time MeridianRx employees are eligible for tuition reimbursement towards Bachelor’s or graduate degrees.
    • A bright and engaging company culture; the Meridian family of companies has been recognized as one of Metro Detroit’s Best and Brightest Companies to Work For 5 years in a row. 


    Equal Opportunity Employer




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