10 days old

Contracts Administrator- Genoa Healthcare, Eagan MN or Renton WA

Eagan, MN 55122
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Opportunities with Genoa Healthcare. A career with Genoa Healthcare means you're part of a collaborative effort to serve behavioral health and addiction treatment communities. We do more than just provide medicine: we change lives for the better. People with serious mental or chronic illness - and those who care for them - have moving stories, and at Genoa we become their voice, their partner. Working as part of a coordinated care team, we partner with community-based providers and others to ensure that people with complex health conditions get the right medications and are able to follow their treatment plans. Our personalized services - in-clinic pharmacies, telepsychiatry and medication management - are leading the way to a new level of care.

 We recently joined OptumRx, a pharmacy care services company that is part of Optum and UnitedHealth Group's family of businesses. We are part of a leading information and technology-enabled health services business dedicated to making the health system work better for everyone. Take a closer look to learn why a career with Genoa Healthcare might be the path to discovering your life's best work.SM

Summary of Functions:

The Senior Credentialing Rep will support the efforts of the payer relations team by resolving pharmacy payer contracting needs for new and existing pharmacy locations as it pertains to the following:  Medicaid Enrollment, Medicare Enrollment, Group Purchasing Organization (GPO) Applications, direct Pharmacy Benefit Manager (PBM) contracts, and related contracting needs. Responsibilities also include updating Genoa's Licensing and Tracking Database, Electronic Funds Transfer (EFT) and 835 enrollment, pharmacy network enrollment through existing contracts and act as resource for Genoa associates.  

Duties & Responsibilities:
  • Respond in a timely manner to all emails from internal and external customers using the Payer Relations Service Model
  • Research and assist pharmacies with claim rejections from Medicaid, health plans and PBM's to obtain paid claims
  • Identify network access gaps and obtain contracts for pharmacy participation
  • Manage SharePoint files and other required Databases
  • Manage and maintain the process for triaging pharmacy network rejections for all pharmacy locations and work with PBMs/Payers to close gaps and obstacles to gain access to pharmacy networks.
  • Collaborate with internal Accounting Team and reconciliation vendor to resolve issues with missing 835s/remits, payments, rejections, etc.
  • Conduct monthly calls with new sites for contracting needs and provide a summary of the meeting notes and expectations
  • Effectively communicate with licensing and contracting team for implementing and existing sites to ensure all requirements are met for contracting needs
  • Apply and obtain Medicaid provider ID in a timely manner
  • Assist with applying and obtaining Medicare provider IDs in a timely manner
  • Respond to PBM and Medicaid Revalidation Requests in the required time frame
  • Support Fraud Waste and Abuse (FWA) attestations  and regulatory compliance efforts
  • Communicate new pharmacy network loads to each health plan and PBM where applicable
  • Provide Medicaid enrollment to managed care Medicaid health plans and PBM's
  • Other duties as assigned

Posted: 2020-05-16 Expires: 2020-06-15

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Contracts Administrator- Genoa Healthcare, Eagan MN or Renton WA

UnitedHealth Group
Eagan, MN 55122

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