20 days old

Network Contract Administrator - 945203

Golden Valley, MN 55427
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  • Job Code
    945203

Opportunities with Genoa Healthcare Network Contract Administrator Golden Valley MN

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With hundreds of pharmacies across the country, a career with Genoa Healthcare means youre part of changing the lives of those with behavioral health and other complex conditions. People with serious illnesses and those who care for them have incredibly moving stories, and at Genoa we are their partner. We partner with community-based providers and others so they get the right medications and are able to follow their treatment plans.

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We are part of OptumRx (and UnitedHealth Group), which is 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

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Summary of Functions:

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The Network Contracts Specialist 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 Genoas Licensing and Tracking Database, Electronic Funds Transfer (EFT) and 835 enrollment, pharmacy network enrollment through existing contracts and act as resource for Genoa associates.

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Duties & Responsibilities:

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

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  • 3-5 years pharmacy or related healthcare experience required
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  • High degree of time management and organizational skills
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  • Proficient user of Microsoft Office
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  • Pharmacy Technician License preferred, but not required
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Physical Demands:

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The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Posted: 2021-07-13 Expires: 2021-08-12

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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Network Contract Administrator - 945203

UnitedHealth Group
Golden Valley, MN 55427

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