Credentialing Specialist I Amazon Pharmacy
Credentialing Specialist I Amazon Pharmacy
Posted on :
28-04-2025
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1 Vacancy
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Job Description
Amazon Pharmacy is committed to build the future of pharmacy by offering technology solutions that drive and enable us to be the worlds most customer centric pharmacy option. The Payer Operations team is seeking an L4 Risk Manager to develop and execute foundational reporting risk analysis and tactical requests from internal stakeholders. This position will be heavily involved in crossfunctional activity and external PBM & State Medicaid communications. This individual will build and scale operational processes for pharmacy credentialing and launches while ensuring alignment with 3P risks and regulatory requirements. Payers represent 88 of US prescription spend and a clean and organized input filing is a requisite for APs success. This role is critical to AP as it is the primary mechanism to maintain payer credentials and reduce unintended network impacts. The ideal candidate will have a broad understanding of the healthcare sector with strong organizational skills an analytical toolset to deep dive create efficiencies manage risk tolerances and optimize existing policies.
Key job responsibilities
Streamline Payer & Medicaid credentialing and crossteam processes by introducing improved controls enhancing operational efficiency and successfully delivering projects
Manage upstream dependencies (Payer Relations Compliance Ops Compliance Tax Legal Global Risk Ops & Biz Tech) and downstream dependencies (FinOps Reimbursement Audit Accounting B2B and Quality) to ensure timely & accurate collection validation and ultimately dissemination of information to external customers.
Develop tracking mechanisms and implement risk management policies by partnering with Legal & Compliance stakeholder groups to proactively minimize identified risks and reactively address operational gaps.
Improve existing processes iteratively and introduce new initiatives to help drive down risk while meeting compliance and policy requirements as it pertains to financial penalties customer accessibility insurance coverage of new FCs electronic remittance and payments.
Handle daytoday stakeholder inquiries route payer correspondence to the relevant owners and collaborate with partner teams to drive projects while creating longterm scalable solutions that improve stakeholder accountability.
Evaluate and address potential risks to the company with upstream and downstream stakeholder groups including network termination financial penalties operational blockers and payer compliance risks.
Ensure compliance with relevant laws and regulations through collaboration with crossfunctional teams.
Work backwards with key stakeholders in developing proactive mechanisms in order to evaluate operational gaps and scope out new business initiatives considering the potential risks and rewards.
Provide expert guidance and support to team members on risk management escalation and issues.
Stay informed of industry developments changing regulations and emerging risks in the pharmacy sector.
3 years of experience managing financials/projects Bachelors degree.
Experience in owning and navigating financial metrics in a disrupted industry.
Ability to understand crossfunction interdependence among partner teams.
Advanced proficiency in MS Excel Word document writing.
Basic understanding of the Pharmaceutical industry including PBMs manufacturers distributors providers and payers.
Excellent communication/interpersonal skills analytical and problemsolving skills.
Credentialing and/or Risk Management experience.
CPCS certification from NAMMS or Certified Risk Manager (CRM) is a plus.
Strong quantitative skills and ability to dive deep into data to distill and communicate root cause.
Strong ownership with ability to toggle between tactical and strategic activities.
Manage and lead crossfunctional meetings.
Experience working for or with PBMs manufacturers distributors or providers.
Amazon is an equal opportunity employer and does not discriminate on the basis of protected veteran status disability or other legally protected status.
Our inclusive culture empowers Amazonians to deliver the best results for our customers. If you have a disability and need a workplace accommodation or adjustment during the application and hiring process including support for the interview or onboarding process please visit for more information. If the country/region youre applying in isnt listed please contact your Recruiting Partner.
Our compensation reflects the cost of labor across several US geographic markets. The base pay for this position ranges from $50100/year in our lowest geographic market up to $107200/year in our highest geographic market. Pay is based on a number of factors including market location and may vary depending on jobrelated knowledge skills and experience. Amazon is a total compensation company. Dependent on the position offered equity signon payments and other forms of compensation may be provided as part of a total compensation package in addition to a full range of medical financial and/or other benefits. For more information please visit This position will remain posted until filled. Applicants should apply via our internal or external career site.
Key job responsibilities
Streamline Payer & Medicaid credentialing and crossteam processes by introducing improved controls enhancing operational efficiency and successfully delivering projects
Manage upstream dependencies (Payer Relations Compliance Ops Compliance Tax Legal Global Risk Ops & Biz Tech) and downstream dependencies (FinOps Reimbursement Audit Accounting B2B and Quality) to ensure timely & accurate collection validation and ultimately dissemination of information to external customers.
Develop tracking mechanisms and implement risk management policies by partnering with Legal & Compliance stakeholder groups to proactively minimize identified risks and reactively address operational gaps.
Improve existing processes iteratively and introduce new initiatives to help drive down risk while meeting compliance and policy requirements as it pertains to financial penalties customer accessibility insurance coverage of new FCs electronic remittance and payments.
Handle daytoday stakeholder inquiries route payer correspondence to the relevant owners and collaborate with partner teams to drive projects while creating longterm scalable solutions that improve stakeholder accountability.
Evaluate and address potential risks to the company with upstream and downstream stakeholder groups including network termination financial penalties operational blockers and payer compliance risks.
Ensure compliance with relevant laws and regulations through collaboration with crossfunctional teams.
Work backwards with key stakeholders in developing proactive mechanisms in order to evaluate operational gaps and scope out new business initiatives considering the potential risks and rewards.
Provide expert guidance and support to team members on risk management escalation and issues.
Stay informed of industry developments changing regulations and emerging risks in the pharmacy sector.
3 years of experience managing financials/projects Bachelors degree.
Experience in owning and navigating financial metrics in a disrupted industry.
Ability to understand crossfunction interdependence among partner teams.
Advanced proficiency in MS Excel Word document writing.
Basic understanding of the Pharmaceutical industry including PBMs manufacturers distributors providers and payers.
Excellent communication/interpersonal skills analytical and problemsolving skills.
Credentialing and/or Risk Management experience.
CPCS certification from NAMMS or Certified Risk Manager (CRM) is a plus.
Strong quantitative skills and ability to dive deep into data to distill and communicate root cause.
Strong ownership with ability to toggle between tactical and strategic activities.
Manage and lead crossfunctional meetings.
Experience working for or with PBMs manufacturers distributors or providers.
Amazon is an equal opportunity employer and does not discriminate on the basis of protected veteran status disability or other legally protected status.
Our inclusive culture empowers Amazonians to deliver the best results for our customers. If you have a disability and need a workplace accommodation or adjustment during the application and hiring process including support for the interview or onboarding process please visit for more information. If the country/region youre applying in isnt listed please contact your Recruiting Partner.
Our compensation reflects the cost of labor across several US geographic markets. The base pay for this position ranges from $50100/year in our lowest geographic market up to $107200/year in our highest geographic market. Pay is based on a number of factors including market location and may vary depending on jobrelated knowledge skills and experience. Amazon is a total compensation company. Dependent on the position offered equity signon payments and other forms of compensation may be provided as part of a total compensation package in addition to a full range of medical financial and/or other benefits. For more information please visit This position will remain posted until filled. Applicants should apply via our internal or external career site.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
Key Skills
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