Description review
Associate, Payer Contracting & Credentialing
Pharmacy1st Health · Washington, D.C., Remote · back to the listing
HR standards
68/100
needs work
Title ↔ description
79/100
solid
Reads as
Unclear
no confident match
What this role officially is
operations manager — ESCO, the EU occupation classification
Operations managers plan, oversee and coordinate the daily operations of production of goods and provision of services. They also formulate and implement company policies and plan the use of human resources and materials.
Also known as: division operations manager, operations administrator, operations supervisor, operations general manager, operations director, business operations manager
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What the listing never says
- 16 bullet points. Long requirement lists deter qualified candidates, who read them as hard gates. Scope clarity
- No pay range published. Candidates cannot tell whether applying is worth their time. Pay transparency
The listing, marked up
Nothing in the wording of this listing tripped a check. The scores above still judge how complete and coherent it is.
Pharmacy1st Health is building the clinical infrastructure for rural America by transforming independent pharmacies into integrated care delivery hubs. Our model combines primary care, pharmacy services, and chronic disease management under one roof, creating a new, lower-cost site of care for underserved communities.
We operate across multiple states and are rapidly expanding a network of rural clinics co-located with pharmacies. Our goal is to deliver scalable, high-quality care while improving access, outcomes, and cost efficiency.
Role Overview
You'll own payer contracting and credentialing for newly acquired pharmacies. The core of the job is building repeatable processes for PBM change of ownership (CHOW) and state Medicaid and Medicare Part B recontracting, then running those processes for every acquisition we close. You'll also lead our onboarding to Elevate's concierge service so all payer payments reconcile in one place. You'll work closely with Operations, Finance, our pharmacists-in-charge, and outside partners, and you'll be the person who knows the status of every location's contracts at any moment.
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.
We operate across multiple states and are rapidly expanding a network of rural clinics co-located with pharmacies. Our goal is to deliver scalable, high-quality care while improving access, outcomes, and cost efficiency.
Role Overview
You'll own payer contracting and credentialing for newly acquired pharmacies. The core of the job is building repeatable processes for PBM change of ownership (CHOW) and state Medicaid and Medicare Part B recontracting, then running those processes for every acquisition we close. You'll also lead our onboarding to Elevate's concierge service so all payer payments reconcile in one place. You'll work closely with Operations, Finance, our pharmacists-in-charge, and outside partners, and you'll be the person who knows the status of every location's contracts at any moment.
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.