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.


General Job Information


Pharmacy Benefits Configuration Coordinator II


Job Family

Operations Group


United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

Date Requisition Created

Minimum Qualifications


GED, High School

License and Certifications

  • Required

License and Certifications

  • Preferred

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

  • Pharmacy

Other Job Requirements


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

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

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Enrollment Med D Coordinator II

CVS Health

Posted 2 days ago

VIEW JOBS 3/19/2019 12:00:00 AM 2019-06-17T00:00 Job Description * The Enrollment Coordinator II plays a critical role in working with our new Medicare Part D member clients to determine eligibility and perform various enrollment activities. Interfacing with both individual plan members and employer groups, the position will work in accordance with Center for Medicare/Medicaid Services (CMS) guidelines to ensure regulatory compliance. This position requires a strong focus around accurate and timely customer support to ensure client enrollment and retention. The Coordinator II will need to prioritize daily tasks and work items in queue, manage turnaround times, and manage items that need escalation. The position will partner cross-functionally with various operational business units while supporting departmental objectives within company and regulatory guidelines. The Coordinator II has the key responsibility of managing enrollment, disenrollment or various other tasks which could include: processing incoming items into MedForce application; tracking special projects in Excel and managing outbound enrollment verification member calls, LEP, LIS, Letters and Account Updates. Required Qualifications 1+ years of relevant work experience required Team oriented but with the ability to work independently Proficient in Microsoft Office Suite Excellent verbal/written communication skills Flexibility Preferred Qualifications * 1 year of healthcare industry experience. including Medicare Part D and patient/member services * Understanding of healthcare terminology and definitions * Minimal understanding of CMS guidelines for Medicare Part D Education Verifiable High School Diploma or GED - Required Business Overview It's a new day in health care. Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation's premier health innovation company. Through our health services, insurance plans and community pharmacists, we're pioneering a bold new approach to total health. As a CVS Health colleague, you'll be at the center of it all. We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability. CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran – we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team. Please note that we only accept applications for employment via this site. If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. CVS Health Scottsdale AZ

Pharmacy Benefits Configuration Coordinator II

Magellan Health Services