Pharmacy Benefit Plan Administrator I
Virginia, Missouri, Arizona
Job DescriptionThis position`s primary functions are researching benefit related inquiries, leading benefit projects, taking ownership of duties for assigned coding and audit accounts, gathering and analyzing benefit setup and coding requirements, testing and validating benefit setups, and effectively communicating all benefit changes to stakeholders through technical documentation. 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.
-Responsible for accurate implementation and coding of pharmacy plan benefits changes, and new plan benefit designs into the appropriate adjudication system.
-Gathers and analyzes client requirements, assesses the benefit impact on current design and claims processing, presents to the stakeholder and/or other internal partners with benefit setup options, and advises on the best solution.
-Assists in audit process through unit testing of benefit coding, peer testing, and timely resolution of all research/issues presented by the QA team.
-Timely management of all assigned pharmacy benefit accounts, and ancillary projects.
-Troubleshoots inquiries from both internal and external partners, and provides solutions to meet client intent and needs.
-Establishes cross department relationships to ensure the success of all pharmacy plan benefit responsibilities.
-Demonstrates an understanding or end user business needs, and works closely with end users to identify problems and provide solutions.
-Contributes creative solutions to improve operational efficiency and effectiveness of all Pharmacy Benefits lines of business.
-Contributes to program and coding improvements by using continuous quality improvements process, by being proactive in identifying improvement opportunities and by contributing on-going consultation and collaboration with stakeholders.
-Partners with various teams to understand customer specific requirements and configuration and translate those into technical design specification and data flow from which programs are developed and coded.
-Assists in the development of process improvements by providing input on system changes and/or enhancements.
-Other duties as assigned.
General Job Information
TitlePharmacy Benefit Plan Administrator I
Job FamilyOperations Group
CountryUnited States of America
FLSA StatusUnited States of America (Non-Exempt)
Recruiting Start Date11/6/2019
Date Requisition Created11/6/2019
Work ExperienceClaims, Pharmacy
EducationGED (Required), High School (Required)
License and Certifications - Required
License and Certifications - PreferredCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy
Other Job Requirements
Pharmacy benefit management (PBM) experience strongly preferred. Ability to interpret and understand codes/benefits. Ability to understand claims processing systems, and configure 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.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.