Associate, Payer Contracting & Credentialing

Role Overview

Key Responsibilities

• Run PBM CHOWs end to end for each acquired location: NCPDP ownership updates, provider applications, ownership and control disclosures, and supporting document packets for Express Scripts, CVS Caremark, IQVIA, Humana, MedImpact, and regional PBMs.
• Enroll or re-enroll each location with state Medicaid programs and Medicare Part B (DMEPOS/Part B pharmacy enrollment via PECOS/CMS-855S), including revalidations and ownership change reporting.
• Build and maintain the playbook: a standard post-close contracting checklist, timelines keyed to closing date, document templates, and state-by-state Medicaid requirements.
• Track every workstream in our systems (Linear, Notion, Google Drive) so the status, blockers, and deadlines for each location are visible to the team.
• Own the Elevate concierge onboarding for each location and work with Finance to make sure remittances, ERAs, and payments reconcile in one place.
• Spot and escalate risk early, such as claims adjudicating under seller credentials, lapsed enrollments, or recoupment exposure, and prioritize the work accordingly.
• Maintain ongoing compliance obligations tied to contracts: annual attestations, FWA training, credential renewals, and responses to PBM and Medicaid audits or document requests.

Qualifications

• 2–4 years of experience in pharmacy credentialing, payer enrollment, managed care contracting, or PBM network operations. Experience with pharmacy CHOW or acquisitions is a strong plus.
• Working knowledge of NCPDP, PBM provider portals, state Medicaid enrollment, and CMS enrollment (PECOS, 855 forms).
• Very strong organization: you're comfortable running dozens of parallel applications with different deadlines and chasing each one to completion.
• A process builder: you document as you go and like turning a messy one-off into a checklist someone else can follow.
• Clear written communication with PBMs, state agencies, sellers, and internal teams.
• Comfort with tools like Notion, Linear, Google Workspace, and spreadsheets. Interest in using AI tools to automate form-heavy work is a plus.
• What success looks like
• In 90 days: every current location has a documented contracting status, and the CHOW and Medicaid playbooks exist in a usable first version.
• In 6 months: new acquisitions move through PBM CHOW and Medicaid/Part B enrollment on a predictable timeline measured from closing date, with no locations billing under a prior owner's credentials.
• Ongoing: payments across locations reconcile through a single view, and contracting no longer depends on any one person's memory.

What success looks like

Preferred Qualifications

• Comfort with tools like Notion, Linear, Google Workspace, and spreadsheets. Interest in using AI tools to automate form-heavy work is a plus.