Credentialing & Medicaid Specialist – Specialty Pharmacy
• *Credentialing & Medicaid Specialist – Specialty Pharmacy Salary:** $65,000–$72,000 (flexible based on experience) Location: Fully Remote (Working EST hours)
Summary
Our client, a growing specialty pharmacy organization with bi-coastal operations and nationwide licensure, is seeking a Credentialing & Medicaid Specialist to support ongoing payer participation and enrollment activities. This role plays a critical part in maintaining active status with Medicaid programs and payer networks, ensuring seamless operations across multiple sites. This is a stable, well-functioning environment where the right individual can take full ownership of the credentialing function while positioning themselves for long-term growth. What You’ll Do
- Own and manage all Medicaid provider enrollments and revalidations across multiple states
- Prepare and submit enrollment applications, provider updates, and required documentation to Medicaid agencies, PBMs, and health plans
- Maintain accurate and up-to-date credentialing records, including licenses, accreditations, and compliance documentation
- Monitor payer and Medicaid communications, identifying and executing on required actions
- Track credentialing expirations and ensure timely renewals to prevent lapses in participation
- Maintain contract and credentialing repositories, ensuring documentation is organized and accessible
- Partner closely with the Billing team to resolve enrollment issues impacting claims
- Route and manage provider and payer communications internally across Compliance, Operations, and Leadership
- Support contract administration activities, including tracking agreements and amendments What You Bring
- 3–5+ years of direct experience with Medicaid enrollments and provider credentialing
- Experience working for a specialty pharmacy or a rare disease pharmacy
- Background working with PBMs, and managed care environments
- Hands-on experience working with state Medicaid agencies and payer portals
- Strong understanding of payer structures, including Medicaid and PBMs
- Exceptional attention to detail with the ability to manage high volumes of documentation accurately
- Ability to work independently in a fully remote environment with minimal oversight
- Multi-state Medicaid enrollment experience
- Familiarity with PBM and commercial payer requirements
- Knowledge of Medicaid FFS vs. MCO structures
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