Payer Partnerships Administrator

GEMCORE’s continued success has earned us national recognition with Inc. Magazine’s list of America’s Fastest-Growing Companies and with the Cleveland Plain Dealer as Top Workplace 6 years running! We are looking for qualified candidates who share our enthusiasm and drive for winning and want to be part of our caring culture!

Are you looking for a role that is part of a key initiative that is vital for the growth of the organization? All the while allowing for work/life balance? Edwards Health Care Services, Inc., a division of GEMCORE is a well-established and growing healthcare distribution company specializing in highly efficient distribution through its nationwide wholesale, retail, and pharmacy divisions. We are seeking a highly motivated Payer Partnership Administrator to join our high energy, friendly team. The Payer Partnership Administrator’s main responsibility is to assist the payer team with key support functions of 3rd party-payer relationships for the GEMCORE Family of Companies.

• We offer growth opportunities with potential for advancement

• This position is an in-office position located in Hudson, OH

• Schedule is 8:15 am - 5:00 pm, Monday through Friday

• Employer paid vacation

• Benefits available included medical/dental/vision, life, short and long-term disability insurances, and 401K Retirement Savings Plan

• Ongoing training and development

Key duties and responsibilities:

• Research health insurance plans and Pharmacy Benefit Managers (PBMs) provider enrollment and contracting processes.

• Complete and disseminate payer enrollment applications and credentialing/re-credentialing documents on a timely basis.

• Monitor payer’s communications identifying market shifts, fee schedule changes, and other items that impact the relationship and could require action.

• Support payer team with contracting initiatives; including maintaining payer database, reports, and administrative tasks.

• Support payer contract implementation and coordination between cross-functional teams.

• Maintain department communications; including analyzing, reviewing, and delegating various communications to appropriate team members.

Key Requirements:

• Strong knowledge of CPT/HCPC coding is a must.

• Experience working in the Durable Medical Equipment industry (DME) preferred.

• Knowledge of health insurance and PBMs preferred.

• Managed Care, Medicare, Medicaid, and 3rd party-payer enrollment and credentialing experiences helpful.

• Ability to multi-task, adapt to change, and prioritize work assignments.

• Proficient with all Microsoft Office applications Word, Excel, PowerPoint etc. with high business acumen.

• Good organizational skills and practices, and cognitive reasoning ability.

• Strong written and verbal communication skills.

• Light lifting of up to 25 pounds.