Pharmacy Network Administrator (Financial/Conlan)
Company: Magellan Health
Location: Rancho Cordova
Posted on: May 8, 2022
Job Description:
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
Responsibilities1-3 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 TitlePharmacy Network Administrator (Financial/Conlan)
Grade20 Work Experience - RequiredClaims, Healthcare Work
Experience - Preferred Education - RequiredGED, High School
Education - PreferredBachelorsLicense and Certifications -
RequiredLicense 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 their position; and comply with all
applicable legal, regulatory, and contractual requirements and
internal policies and procedures.
Keywords: Magellan Health, Rancho Cordova , Pharmacy Network Administrator (Financial/Conlan), Accounting, Auditing , Rancho Cordova, California
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