Payor and PBM Specialist
$78,000–$95,000 year
Remote · Bedford, Massachusetts, United States
Job Summary
Payor & PBM Specialist responsible for end-to-end credentialing and recredentialing for specialty pharmacies housed within hospital/IDN environments, coordinating submissions to major PBMs (Express Scripts, OptumRx, CVS Caremark) and national health plans, building relationships with payors, PSAOs, and PBMs to ensure network access, and maintaining centralized credentialing files. The role requires in-depth knowledge of PBMs, regulatory requirements, and payer enrollment processes, with a focus on improving workflows and profitability. Ideal candidate has 5 years of healthcare credentialing experience, a Bachelor’s degree or equivalent, strong attention to detail, and excellent communication skills; travel up to 20% is expected.
Required Qualifications
- Bachelor’s degree or equivalent combination of education/experience
- 5 years’ experience in healthcare credentialing and PBM application submissions
- Pharmacy industry experience is highly desired
- Working knowledge of specialty pharmacy operations, licensing, and payer network participation
- Familiarity with CAQH ProView, NPPES, PECOS, and Medicare/Medicaid enrollment portals a plus
- Excellent communication skills with internal and external stakeholders
- Problem-solving mindset with a focus on continuous improvement
- Travel up to 20% annually
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