Pharmacy Benefit Plan Administrator II
Job DescriptionThis position specializes in the analyzing and solving intermediate level of benefit design requirements. This role requires strong attention to detail, extensive pharmacy benefits administration knowledge, and well-honed analytical skills to assist both internal and external stakeholders in implementing and maintaining plan benefits. This position plays a critical role in the formulary administration, benefit programing, implementation, mapping, audit protocols, and validation process. The Plan Administration team as a whole is responsible for the plan benefit management and coding of multiple lines of business (Commercial, Medicaid, Medicare, Affordable Care Act Exchange, and Managed Care) across a number of different adjudication platforms. This position will ensure a high level of quality and accuracy through pharmacy benefit analysis, peer auditing, and strong relationship building with our internal Quality Assurance (QA) resources. Participates in new customer implementations.
- Analyzes new business requirements for benefit designs and changes in order to establish the appropriate solution for our internal and external stakeholders.
- Responsible for accurate administration of plan benefits coding changes, and new plan benefit designs into the appropriate adjudication system.
- Assists in ongoing development and improvement of audit process to include; peer testing solutions, and partnering with QA team resources.
- Maintains customer documentation which validates configuration.
- Maintains technical documentation based on standard operating procedures in support of the assigned clinical application.
- Interacts with Clinical and development team during the software build or configuration and testing process
- Establishes cross departmental relationships to ensure the success of all plan administration responsibilities.
- Leads, coordinates, or consults on intermediate level projects including new customer implementations, global projects spanning multiple clients or systems, and system implementations or enhancements.
- Efficient and effective distribution of tasks, using clear and concise instructions and expectations.
- Prepares updates and reports, including those required for either internal and SOX audits.
- Serves as primary contact for our internal and external customers regarding benefit plan configuration feasibility requests.
- Oversees configuration and testing of system enhancements.
- Partners with testing team to research any discrepancies identified with regression and release testing for system enhancements and/or benefit plans.
- Designs and executes unit, system and integration test plans for new developments/releases/reports.
- Provides support to internal partners responsible for developing, monitoring, improving operational controls related to formulary and benefit coding.
- Provides operational and maintenance support for assigned adjudication system and supporting tools (i.e., CRM, Formulary software).
- Demonstrates an understanding of end user business needs, and works closely with end users to identify problems and provide technical solutions.
- Other duties as assigned.
General Job Information
TitlePharmacy Benefit Plan Administrator II
Job FamilyOperations Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date1/31/2019
Date Requisition Created1/31/2019
License and Certifications - Required
License and Certifications - PreferredCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy
Other Job Requirements
- Strong working knowledge of Microsoft Office suite, specifically Word and Excel, including running queries and macros.
- Experience in interpreting and understanding codes/benefits.
- Experience with claims processing systems and configuring codes/benefits to optimize auto-adjudication.
- Ability to identify and resolve process and/or systems issues.
- Strong sense of urgency leading to the timely completion of all projects, training and assignments.
- Familiarity with government regulations with ability to operationalize and understand how various aspects of regulation is interdependent and related.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled