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

Responsibilities

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

Title

Pharmacy Network Administrator

Grade

20

Work Experience - Required

Claims, Healthcare

Work Experience - Preferred

Education - Required

GED, High School

Education - Preferred

Bachelors

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 their
position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

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