Pharmacy Benefit Plan Administrator II
Company: Magellan Health
Location: Glen Allen
Posted on: October 12, 2021
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
- 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
- Assists in ongoing development and improvement of audit process
to include; peer testing solutions, and partnering with QA team
- Maintains customer documentation which validates
- 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
- 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
- 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
- Demonstrates an understanding of end user business needs, and
works closely with end users to identify problems and provide
- Other duties as assigned.
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
Familiarity with government regulations with ability to
operationalize and understand how various aspects of regulation is
interdependent and related.
Pharmacy Benefit Plan Administrator II
Work Experience - Required
Benefit Plan Administration, Claims
Work Experience - Preferred
Formulary Management, Medicare Part D (MedD)
Education - Required
Education - Preferred
Certifications - Required
Certifications - Preferred
CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements -
Magellan Health, Inc. is proud to be an Equal Opportunity
Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the
security responsibilities and security controls unique to their
position; and comply with all applicable legal, regulatory, and
contractual requirements and internal policies and procedures.
Keywords: Magellan Health, Richmond , Pharmacy Benefit Plan Administrator II, Other , Glen Allen, Virginia
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