Pharmacy Network Administrator (Financial/Conlan)

Pharmacy Network Administrator (Financial/Conlan)

Vacancy expired!

Serves as the departmental resource for assigned credentialing and contracting projects. Projects range from basic to moderate complexity. Using advanced systems knowledge and provider credentialing/contracting information, identifies barriers impacting on meeting credentialing and contracting requirements, develops strategies for resolution and facilitates implementation of a solution. Serves as liaison for external and internal customers of the Credentialing/Contracting Administration and payment center information.

• Manages a variety of credentialing and contracting projects including but not limited to coordination with third-party vendors; provider communications and liaison; creation, design, testing and implementation of specific production and audit reports; pharmacy payment center setup and support; contract rollout and special mailings.
• Serves as liaison to field staff for all assigned geographic locations utilizing knowledge of credentialing and contracting information and network structure to resolve problems, complaints, appeals and other provider issues.
• Coordinates state Fee For Service client's pharmacy network enrollment as assigned.
• Coordinates all EFT and 835 remittance enrollment and issue resolution.
• Coordinates problem resolution in areas of risk, facilitate prioritization of production, and communicates concerns from field staff and State client contacts.
• Assists with the development of commercial pharmacy networks within adjudication systems, network database management, communications database management and RFP responses as assigned by management
• Performs other duties as assigned.

Other Job Requirements

Responsibilities

• Bachelors degree preferred.
• Pharmacy Benefits Management (PBM), managed care or behavioral health experience preferred.
• Experience utilizing quality improvement methodologies preferred.

• 1-3 years of experience in data management, credentialing, claims, insurance administration or health care setting or on the job equivalent required.
• Analysis and problem solving skills required.
• Ability to interface with multi-disciplinary high level professionals.
• Ability to identify barriers and elevate issues.
• Strong interpersonal and communication skills, both written and verbal.
• Ability to establish strong relationships and influence work performance of others.
• Intermediate MS Excel and strong skills in other MS Office products.

General Job Information

Work Experience
Claims, Healthcare

Education
Bachelors, GED (Required), High School (Required)

License and Certifications - Required

License and Certifications - Preferred

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.