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ICONMA

Provider Credentialing Specialist

Detroit, MI · On-site

Provider Credentialing Specialist Our client, a health insurance company, is looking for a Provider ... and Network Development Inquiries. * May be designated by the leader to attend Credentials ...

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Infographic showing various Provider Network Credentialing Specialist job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 11% Part Time, and 6% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $50,665 per year, or $24.4 per hour.

Network Credentialing Specialist

Philadelphia, PA • On-site

Integrated Resources INC
Recruiting and Staffing Services • 51 - 200 employees
Learn more about Integrated Resources INCexternal

Full-time

Re-posted 19 days ago

Key responsibilities

  • Track and monitor pharmacy credentials to ensure compliance with standards and regulations.

  • Communicate with pharmacies regarding compliance lapses, contract issues, and credential updates.

  • Manage and update pharmacy credential information within various data systems and ensure data integrity.

Job description

Company Description

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.

Job Description

Tracking and monitoring pharmacy credentials to ensure compliance with plan standards, accreditation agencies and state and federal regulatory guidelines. Issuing notification to pharmacies when there are lapses in compliance information. Maintaining up to date credentialing on Pharmacies to ensure contract compliance.


Executing updated Pharmacy contract drug rate information. Ensuring contracted rates are properly recorded and communicated within the Argus and the PerformRx data bases. Ensuring integrity is maintained within various data, i.e. Argus SNA and the PerformRx Access database. Reviewing, mailing and communicating with Pharmacy staff on new contracts and other issues as they arise.


Validating Argus SNA system and IPNS to ensure contracted rates are reelected within the claims processing system. Updating information against the NCPDP file for address, new and closed pharmacies, and other key metric information as needed.


Reporting key Pharmacy metric information regarding credentials. Work with contracting to suspend/ remove from network any pharmacies not meeting credential requirements.


Manage and monitor each client network structure with the Pharmacy Network database, SNA and IPNS.


Responding to Pharmacy complaints by researching and communicating issues to internal groups or escalating according to department and company policy. Providing explanations on claim status, policy changes and payment decisions. Coordinating activities impacting inter/intra departments to ensure smooth coordination of members related inquiries.


Maintains proactive and effective communication with all members of the departmental team and communicates any concerns appropriate staff immediately. Continuously evaluates administrative operational procedures and recommends changes as appropriate


Performs other related duties and projects as assigned. Including communications to Pharmacies and other related entities as needed. Participating in executed contract activities as needed. Attends required training as necessary.


Supports and carries out the Mission & Values. Adheres to PerformRx/AMFC policies and procedures. Maintains a current knowledge base of program services, policy and procedures. Regularly reviews and reacts to policy updates and departmental procedures.


Creates and supports an environment which fosters teamwork, cooperation, respect and diversity. Establishes and maintains positive communication and professional demeanor with PerformRx employees and clients at all times. Demonstrates and supports commitment to corporate goals and mission.

Additional Information

Kind Regards,

Kavita Kumari

Clinical Recruiter

732 844 8726

Integrated Resources, Inc.


Integrated Resources logo

About Integrated Resources

Sourced by ZipRecruiter

Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Edison, NJ, US

Year founded

1996

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