Network Configuration Specialist I
Arizona, United States Minor Outlying Islands
Job DescriptionResponsible 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.
- 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
TitleNetwork Configuration Specialist I
Job FamilyPharmacy Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date8/13/2018
Date Requisition Created8/13/2018
EducationBachelors||&& GED||&& High School
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
- 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.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled
Top 5 reasons to work at Magellan
Meaningful Work With People Who Care
At Magellan Health you can do meaningful work and feel confident that you matter in an organization that makes a real difference in the world - one that cares deeply and uses its employees’ collective insight as a competitive advantage.Read More
We are Compassionately Curious
Magellan Health is a place where we listen with real empathy. It’s one of our biggest strengths. It helps us to support each other and develop innovative solutions for the fastest growing, most complex areas of healthcare.Read More
We are Better Together
We rely on our innate ability to work as a high-functioning collaborative team to facilitate compassionate care to all of our members. With such interdependency comes trust, challenge and innovation.Read More
We believe work and life should flow together in unison. We offer resources that match your professional development, a culture that welcomes your ideas, and unparalleled flexibility to fit work around your life.Read More
Be your best at Magellan Health. We’re a collective of remarkably motivated and driven professionals. As a team, we’re proud of the high standards we set for each other and we’re continually inspired to do our best work.Read More
When you sayLife @ Magellan
To be the best you have to work with the bestWe hear you