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Network Admin, LTCP
3 months ago
Managed Health Care Associates, Inc. (MHA), provides care communities with access, solutions, and insights to help them run their businesses more effectively. Our members include post-acute providers across the care continuum including long-term care, home infusion, and specialty pharmacies, as well as senior living and other group living facilities. Our team of associates are passionate about our common mission of helping people age with grace, and champion our core values of being Curious Learners, Selfless Advocates, and Relentless Finishers.
Who we're looking for:
The LTC Network Administrator will be the first point of contact for the Senior LTC Network Administrator and Manager of LTC Network Operations. The LTC Network Administrator will be responsible for managing the day-to-day activities within the department, primarily responsible for onboarding LTC Network members (LTC & select combo pharmacies) and notifying our PBM partners and Finance of new pharmacies or pharmacy updates/changes. The LTC Network Administrator will be the point of contact when fielding questions regarding Network enrollment as well as assisting in conflict resolution and ad hoc requests/inquiries from our PBM partners and LTC pharmacies. He/she will also be a point of contact for the LTCP team for any questions, issues, concerns, etc. specific to MHA LTC Network member onboarding/changes and billing. The right candidate must have pharmacy and insurance knowledge/experience, strong communication skills, verbal and written, and the ability and willingness to collaborate with his/her team as well as associates from different departments on a daily basis.
What You'll Be Doing:
- Collaborate with the Senior LTC Network Administrator on pharmacy onboarding/changes, quarterly billing, compliance & credentialing requirements.
- Coordinate/collaborate with other departments for implementation of software or upgrades/updates to current systems to meet contract standards and proper filing of all pertinent documents, emails and information.
- Maintain knowledge in the terms and content of PBM onboarding paperwork and NCPDP.
- Provide guidance/support to the LTCP team for pharmacy onboarding, EFT/ERA enrollment, OptumRx CMR/MTM program, information changes, credentialing, compliance, etc.
- Maintain involvement in all day-to-day activities within the department as well as with the LTCP teams; "keep your finger on the pulse".
- High School diploma or equivalent and relevant experience required. College Degree preferred.
- 1-2 years' experience with Pharmacy Network Contracting; LTC pharmacy specific a plus.
- 1-2 years' experience with, and working knowledge of, Medicare Part D and Medicaid
- Proficient in Microsoft 365
- Ability to provide subject matter expertise and technical expertise to resolve member needs and issues with network participation agreement and PBM claims processing
- Ability to establish rapport and build relationships with members and business partners
- A strong ability to work cross-functionally within MHA
- Excellent, communication and customer services skills required
- High degree of detail and organizational skills
- Detail Oriented, Organized, Results Driven, Develop Standards, Foster Teamwork, Handle Pressure
- N/A Travel
- Hybrid work environment
Our associates enjoy the following benefits, and you can, too
- Staying Healthy
Comprehensive medical, dental, and vision plans with FSA/HSA options
Fitness reimbursement
Access to an Employee Assistance Program - Enjoying Time-Off
Paid time off, holidays, personal days, paid parental leave, plus your Birthday as a day off - Planning for the Future
Life Insurance, short-term & long-term disability insurance
401K match
Employee Stock Purchase Plan
Voluntary financial and legal benefits, through our benefits providers - Learning Continuously
E-learning programs
Tuition Reimbursement
Ongoing Team Trainings - Making an Impact
Paid volunteer time-off
Donation matching
Managed Health Care Associates, Inc. is an Equal Opportunity Employer and ensures its employment decisions comply with principles embodied in Title VII, the Age Discrimination in Employment Act, the Rehabilitation Act of 1973, the Vietnam Veterans Readjustment Assistance Act of 1974, Executive Order 11246, Revised Order Number 4, and applicable state regulations
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
