Provider Relations Specialist

About Judi Health

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.

At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health.

Location: Hybrid (at least 3 days per week in our NYC, Denver, or Charlotte offices)

Position Summary: 

The Provider Relations Specialist provides essential credentialing review and management to support the Judi Rx networks of pharmacies. This work involves deciding whether pharmacies meeting Judi Rx’s credentialing requirements allowing for inclusion in the Judi Rx pharmacy networks and maintaining the information related to credentialing. The ideal candidate will have experience in credentialing providers, managing reporting requests, and contribute to scalable solutions to streamline processes.  

Six-month temporary engagement with possible conversion to full-time.

Position Responsibilities:

• Manage credentialing for applicable pharmacies for inclusion in the provider networks and maintain the information related to credentialing so that Judi Rx has the most relevant information available. This includes getting applicable licenses and certificates of insurance from pharmacies as well as verifying eligibility in the NCPDP database and federal and state websites (e.g. OIG, GSA, SAM).
• Ensure the applicable pharmacies are valid by reviewing exclusion lists on an ongoing basis to identify any excluded pharmacies and referring those pharmacies to the appropriate team members/departments for removal.
• Manage the development and maintenance of a credentialing database to ensure proper tracking of all relevant credentialing information.
• Manage credentialing reporting requests working with the appropriate internal teams.
• Manage gathering and tracking annual pharmacy required attestations to ensure compliance with contractual and accreditation requirements.
• Develop applicable credentialing policies and procedures.
• Gather pertinent information from pharmacies regarding services offered and opportunities and provide direct contracting support to Provider Relations leadership as needed.