Capsule is rebuilding the $425 billion pharmacy industry from the inside out with an emotionally resonant pharmacy experience that works for everyone, & technology that enables customized outcomes for patients, doctors, hospitals, insurers, & manufacturers. Our team is laser focused on creating the best healthcare experience for our customers, & driving meaningful value & better outcomes for every participant in the healthcare system. Everyone who uses Capsule raves about it - we have 5,000+ five-star app reviews - & were expanding quickly to get that experience in the hands of as many people as possible. Weve raised over $250 million from the best internet & healthcare investors to enable that expansion.
Our values are: everybody needs some looking after sometimes & winning together. People succeed in our culture when they are intensely focused on our customers, energized to accomplish ambitious goals, & push themselves & those around them to be better. We work hard to teach & share our successes to help others be successful. We anticipate our teammates needs & communicate early & often, using the input of our peers to operate both fast & right. We have tremendous ambitions & a lot of fun pursuing them if that excites you, wed love to have you join us.
About the Role:
As a Capsule Medicare/Medicaid & Credentialing Associate, you will be on the frontline of Capsules mission to build a pharmacy that works for everyone. You will be responsible for establishing network access of Capsule ensuring that Capsule provides a Healthcare experience that works for everyone. In this role you will report to the Head of Contracting & partner with both the Legal Team & the Licensing & Compliance teams.
- Ensure network access through initial enrollment, & re-enrollment of Medicare, Medicaid, & Fee For Service networks.
- Ensure NCPDP enrollments & updates. Maintain online & credentialing requests.
- Apply for all NPI Enrollment & updates with NPPES.
- Ensure all Payer credentialing & recredentialing happens on time & accurately.
- Responsible for daily document review process & back end maintenance of central repository for all payer credentialing, Enrollments, Contract terms, & serve as liaison as data is needed.
- You take pride in enabling the best work of others on the team. You think ahead to anticipate the needs of your teammates & you give & get all the facts making it easy for others to make decisions.
- You drive results in a way that makes everyone better. You accomplish ambitious objectives while uplifting the team around you. You're a magnet for team members looking to get better & be successful.
- You work hard & want to have fun while you do so. You celebrate wins & remember to enjoy the journey as we build something iconic.
- You can work both fast & right & don't view them as trade-offs. You understand when things require precision & accuracy & where 80% gets you to the desired outcome.
- You thrive on being pushed & challenged. You communicate effectively both in written form & live / on your feet - you are not fazed by tough questions in the moment.
- You strike the right balance between putting enough work in to share something, but not going off into a corner for weeks at a time to polish something to perfection.
- You operate like an owner & expect others to as well. You take personal responsibility & value personal responsibility in others.
- You check your ego at the door. You are interested in finding the right answer vs. always having the right answer.
- Associate degree in Accounting, Healthcare Administration, Business or Law and/or at least two (2) years of pharmacy licensure experience, as well as Medicare & Medicaid enrollment experience as a healthcare provider or working for a pharmacy provider.
- Minimum of one (1) year Experience with Medicare & Medicaid enrollment process.
- Minimum of one (1) year Experience with PBM Credentialing & familiarity with NCPDP & NPPES enrollment.
- Knowledge of BOP & DEA license application requirements & rules.
- Highly accurate & efficient problem solving, organizational & planning skills.
Capsule is committed to hiring the best team possible to build a pharmacy that works for everyone. We have a diverse set of problems to solve, & believe that we need a diverse set of perspectives to deliver the best possible solutions to those problems. We look for talent from a wide range of backgrounds - including but not limited to - race, age, sexual orientation, gender identity & expression, national origin, religion, disability, & veteran status.