Pharmacy Benefits Configuration Coordinator II

Magellan Health Services Scottsdale , AZ 85250

Posted 1 week ago

This 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.

#LI-KB1

General Job Information

Title

Pharmacy Benefits Configuration Coordinator II

Grade
21

Job Family

Operations Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date
3/6/2019

Date Requisition Created
1/23/2019

Minimum Qualifications

Education

GED, High School

License and Certifications

  • Required

License and Certifications

  • Preferred

CPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements

  • Pharmacy

Other Job Requirements

Responsibilities

Minimum Requirements?Education: Associates DegreeExperience: 3-5 years

Industry: Previous Pharmacy experience required


Knowledge, Skills, Abilities: 35 WPMAn equivalent combination of experience and education is acceptable.Other?Ability to analyze benefit plans to demonstrate a benefit structure with an automated claims processing system, based on an understanding of the systems functionality and an understanding of business policies. Ability to identify issues and bring them to resolution.Computer

Skills:
Experience with MS Office and database tools

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled


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Pharmacy Benefits Configuration Coordinator II

Magellan Health Services