Magellan Health Services Pharmacy Network Administrator in United States
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
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., Bachelors degree preferred.Pharmacy Benefits Management (PBM), managed care or behavioral health experience preferred.Experience utilizing quality improvement methodologies preferred.
General Job Information
Pharmacy Network Administrator
Work Experience - Required
Work Experience - Preferred
Education - Required
GED, High School
Education - Preferred
License and Certifications - Required
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to theirposition; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive.
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