Pharmacy Network Administrator

Job ID: 579-1Magellan Health

Job Title: Pharmacy Network Administrator

Location: Glen Allen VA 23060 (100% remote)

Duration: 3 months

Job Description:

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.

RESPONSIBILITIES: 1-3 years of experience in data management, credentialing, claims, insurance administration or health care setting or on the job equivalent required. An equivalent combination of experience and education is acceptable. 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. Pharmacy Benefits Management (PBM), managed care or behavioral health experience preferred. Experience utilizing quality improvement methodologies preferred.

WORK EXPERIENCE: Claims Healthcare 1+ years EDUCATION: Bachelors or Combination of Education and Work Experience May Be Considered (Required)