What are the responsibilities and job description for the Managed Care Specialist position at AIS Healthcare?
AIS Healthcare is the leading provider of Targeted Drug Delivery (TDD) and Infusion Care With our diverse culture, and our values around Innovation, Stewardship, and Unity, we are committed to Advancing Quality, and Improving Lives. We are dedicated to doing more for our patients by providing quality products and services that enhance the entire care experience.
AIS Healthcare is looking for a Managed Care Specialist that will be responsible for supporting the end-to-end payor credentialing lifecycle for a national network of specialty pharmacies and infusion centers. This includes coordinating credentialing and recredentialing processes, validating provider data, and ensuring documentation meets payor, regulatory, and accreditation standards. The role requires proficiency in credentialing platforms, data tracking systems, and cross-functional workflows to support contract execution, maintain active network status, and prevent service disruptions due to credentialing gaps.
AIS Healthcare offers great benefits, including health, vision and dental insurance, long term disability insurance, life insurance, a vacation package, 401K plan with a generous employer match, hybrid office/work from home opportunity, growth, and more! Additionally, we offer a 100% work from home model.
Education And Experience
Complete the required Culture Index Candidate Assessment (Directions to follow below in this job posting, so please read in its entirety).*** No application will be considered if the applicant does not follow instructions and complete the assessment as part of the application process.
Culture Index Candidate Assessment
Why does AIS utilize the Culture Index Assessment?
AIS Healthcare is looking for a Managed Care Specialist that will be responsible for supporting the end-to-end payor credentialing lifecycle for a national network of specialty pharmacies and infusion centers. This includes coordinating credentialing and recredentialing processes, validating provider data, and ensuring documentation meets payor, regulatory, and accreditation standards. The role requires proficiency in credentialing platforms, data tracking systems, and cross-functional workflows to support contract execution, maintain active network status, and prevent service disruptions due to credentialing gaps.
AIS Healthcare offers great benefits, including health, vision and dental insurance, long term disability insurance, life insurance, a vacation package, 401K plan with a generous employer match, hybrid office/work from home opportunity, growth, and more! Additionally, we offer a 100% work from home model.
Education And Experience
- 3 years’ experience in completing payor credentialing applications through various methods.
- Experience with key website/databases (i.e. NCPDP, NPPES, PECOS, CAQH)
- Experience managing multiple applications at once and working efficiently to meet or exceed deadlines; preferably in home infusion, specialty pharmacy, and/or provider services.
- Ability to correctly interpret and utilize provider taxonomy, NPI, and other identifiers in payor credentialing applications.
- Medicare and Medicaid enrollment and revalidation.
- Experience navigating contract management software preferred.
- Coordinate payor credentialing and recredentialing activities for specialty pharmacies, infusion centers, and affiliated clinical providers.
- Prepare and submit payor-specific credentialing applications, ensuring accuracy, completeness, and adherence to submission timelines.
- Maintain organized and up-to-date documentation for pharmacy licenses, insurance, accreditations, and provider credentials required by payors within credentialing resource tool.
- Serve as the primary point of contact with payor credentialing departments to resolve application issues, resolve delays, and ensure timely approvals.
- Track credentialing status and milestones within Salesforce to enable proactive reporting and communicate updates to internal stakeholders.
- Maintain detailed records and documentation required by commercial, government, and third-party payors.
- Recognizes patients’ rights and responsibilities and supports them in the performance of job duties, respects patient’s rights to privacy and confidentiality.
- Perform additional duties as assigned by leadership to support department goals and business priorities.
- Self-motivated to achieve goals and objectives
- Demonstrate excellent organizational and time management skills.
- Demonstrate extreme attention to detail and accuracy.
- Customer-orientation with both internal and external customers.
- Ability to handle multiple tasks simultaneously.
- Results-oriented with the ability to manage priorities and projects in a fast-paced, time-sensitive environment.
- Proficient in Microsoft Office, including Outlook, Word, and Excel.
Complete the required Culture Index Candidate Assessment (Directions to follow below in this job posting, so please read in its entirety).*** No application will be considered if the applicant does not follow instructions and complete the assessment as part of the application process.
Culture Index Candidate Assessment
Why does AIS utilize the Culture Index Assessment?
- We recognize how important our employees are to the success of our company. Our company continues to thrive due to a culture of teamwork and our ability to match potential hires with positions that best utilize their natural traits and skillsets. AIS utilizes the Culture Index Candidate Assessment surveys to help us select the best match for our positions.
- Copy and paste the following link into your browser and press enter. Then, select the corresponding position for which you are applying. (Only one assessment per candidate is required.) The assessment is brief, taking less than ten minutes to complete.
- AIS HealthCare™ is the leading provider of advanced sterile, patient-specific intrathecal pump medications and in-home intravenous infusion, including immune globulin therapies. These services, combines with your advanced nursing and care coordination solutions, assist physicians and hospitals in delivering a superior level of care for optimal therapeutic outcomes.
