Network Configuration Specialist I

Arizona, United States Minor Outlying Islands

Job Description

Responsible for accurately configuring pharmacy networks in the claims payment systems. Identifies network configuration issues while working with other team members throughout Magellan, ensuring pharmacy networks are configured based on customer, contract and regulatory requirements.

#LI-KB1
  • Loads pricing from pharmacy contracts into the appropriate pharmacies/networks with high degree of accuracy.
  • 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.
  • Responsible for peer quality checks as it relates to pricing and network loads.
  • Assists the testing team by researching discrepancies identified with regression and release testing related to system enhancements and/or network set up.
  • Configures the appropriate pharmacy networks into the claims system from information received from implementation team , ensuring that appropriate networks are provided to the Benefit Configuration team and attached to the appropriate plans.
  • Prepares updates and reports as required.
  • Assists in the development of process improvements.
  • Provides input on specifications related to system changes and/or enhancements.
  • Provides diagnosis and solves technical issues.
  • Engages other functional areas/departments when necessary to work through projects.
  • Tests system enhancements with a high degree of accuracy.
  • Other duties as assigned.

General Job Information

Title

Network Configuration Specialist I

Grade

20

Job Family

Pharmacy Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

8/13/2018

Date Requisition Created

8/13/2018

Minimum Qualifications

Education

Bachelors||&& GED||&& High School

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • High level of understanding of benefit configuration functions.
  • Working knowledge of either Laker, FirstRx or DST systems OR comparable system(s).
  • Ability to interpret and understand codes/networks.
  • Ability to understand claims processing systems, and configure codes/networks to optimize auto-adjudication.
  • Ability to identify and resolve process and/or systems issues.
  • Strong working knowledge of Microsoft Office Product Suite.
  • Strong sense of urgency leading to the timely completion of all projects, training and assignments.
  • Organized and comfortable multi-tasking.

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