About Pharmacare:
Care Done Right For over 90 years, Pharmacare Hawaii has been providing care to its patients with the same Aloha Spirit as they did for generations. Today this third generation locally owned and operated pharmacy employs nearly 200 employees over its locations on Oahu, Maui, Kauai and Hilo. Be part of the team that is committed to helping improve the health of our community. 2025 Hawaii Business Magazine Top 250 Company
Job Summary:
The Healthcare Insurance Payor Contracts & Credentialing Specialist is responsible for overseeing payor contract data, streamlining provider enrollment, and maintaining regulatory compliance across all health plans. This position acts as a critical link between contracting, credentialing, billing, and operational teams to ensure seamless revenue cycle management, prevent reimbursement disruptions, and ensure provider directory accuracy.
Key Responsibilities:
Provider Enrollment & Credentialing Operations
- Execute end-to-end provider enrollment, primary source verification, and re-credentialing with commercial, Medicare, Medicaid, and managed care payors.
- Maintain accurate records in provider enrollment databases (e.g., CAQH, NPPES, PECOS) and state licensing boards.
- Prepare and support delegated credentialing audits, payor directory reviews, and roster submissions.
Contract Analysis & Data Integrity
- Maintain internal contract management systems, fee schedules, payor lines of business (LOB), and fee schedule effective dates.
- Audit and reconcile payor directory listings regularly to ensure strict compliance with contractual and regulatory standards.
- Track contract amendments, rate changes, and expiration dates to ensure timely renewals and updates.
Revenue Cycle & Issue Resolution
- Investigate and resolve credentialing- or contract-related claim denials and billing holds in collaboration with billing and receivables teams.
- Identify root causes of payor enrollment bottlenecks and implement workflow improvements to reduce time-to-in-network status.
- Serve as a subject matter expert and key liaison for payor representatives regarding enrollment status, contracting updates, and demographic changes.
Schedule: Monday through Friday, 8:30 am - 5:00 pm
This position is in-person at our office in Honolulu.
Minimum Qualifications:
- Experience: 2+ years of hands-on experience in healthcare payor contracting, provider enrollment, or credentialing.
- Systems Proficiency: Direct experience with CAQH ProView, PECOS, NPPES, and electronic credentialing management software.
- Knowledgeable of MS Office applications including Word, Excel, Outlook, Teams, etc.
- MUST be able to pass a background check and drug screen
Preferred Qualifications
- Education: Associate or Bachelor’s degree in Healthcare Administration, Business, or related field preferred (equivalent practical experience considered).
- Certifications: Certified Professional Credentialing Specialist (CPCS) or Certified Provider Credentialing Specialist credential a strong plus.
- Technical Tools: Familiarity with AI-assisted credentialing tools, automated license-monitoring platforms, and practice management/EHR platforms.
- Core Competencies: Exceptional attention to detail, strong data management skills, and clear professional communication.
- Good verbal and written communication skills
Job Type: Full-time
Pay: $30.00 - $35.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Application Question(s):
- Are you able to pass a background check and drug screen?
Experience:
- hands-on healthcare payor contracting: 2 years (Required)
- hands-on provider enrollment: 2 years (Required)
- hands-on credentialing: 2 years (Required)
- electronic credentialing management software: 2 years (Required)
Ability to Commute:
- Honolulu, HI 96819 (Required)
Work Location: In person
