Meridian

  • Pharmacy Network Management Team Lead

    Job Location US-MI-Detroit
    Job ID
    2018-6649
    Category
    Pharmacy
    Business Line
    MRx
  • Overview

    Who we are: 

     

    MeridianRx is a full-service Pharmacy Benefit Manager (PBM) committed to driving down costs and elevating quality. Our clients experience better quality outcomes, thanks to effective clinical support, patient education, and specialty pharmacy programs.  

     

    We work with a diverse range of clients, from members to healthcare providers to plan administrators. MeridianRx services clients across the country and our network continues to grow.   

     

    Our employees work hard, play hard, and give back. MeridianRx employees enjoy: Happy hours, special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.  

     

    A Day in the Life of a Network Administration & Operations Team Lead:

     

    The Network Administration and Operations Team Lead will oversee end-to-end operational aspects of administration, analysis, and quality assurance in pharmacy network design and management. Responsible for the oversight and maintenance of daily network operations and administration duties, ensuring data integrity and overall network claims adjudication performance within the MeridianRx Merlin and Atlas systems. The team lead will provide guidance or expertise to less experienced administration specialist as well as review work performed by others and provides recommendations for improvement.

    Responsibilities

    • Monitors and addresses all aspects of maintenance related to pharmacy network functions including, but not limited to:
      • Provider contract pricing implementation
      • Network plan design builds
      • Quality assurance measures; and
      • Prescription claims processing in general.
    • Responsible for the accurate implementation and maintenance of contract data within the Merlin and Atlas systems, ensuring the overall integrity of the database as it relates to pharmacy contracts and the pharmacy network
    • Acquires and maintains a thorough understanding of all implications of adjudication platform changes while coordinating accordingly with all upstream and downstream stakeholders
    • Effectively identifies issues to claims processing and proposes sustainable solutions or immediate resolution.
    • Initiates and assists coordination with internal teams, such as IT, Client Services, in order to improve efficiency, accuracy, and capacity of network adjudication platform functionality
    • Oversees all contractual administration activities including but not limited to the timely loading of contracts and network set up
    • Develops training material and supervises the training of new network administration staff to achieve a steep learning curve and enable high contribution in a short period of time
    • Maintains and monitors team’s performance as it relates to the administrative and operational duties of the department
    • Supports contract activity including but not limited to the generating of contracts and amendments, facilitates legal and executive review and approval of all contract terms and conditions
    • Serves as SME of Pharmacy Network operations in order to properly support other departments, particularly Network Relations, Client Services, IT, Finance, Sales, and Network Development
    • Assists in resolving intricate pharmacy provider issues and complaints. Researches problems and collaborates with internal/external partners to resolve escalated issues
    • Responsible for and oversees the daily operational activities of the department including but not limited to service desk ticket request, reporting request, contract and network updates, EFT set up, network communication and outreach, and pharmacy manual maintenance
    • Serves in the stead of Pharmacy Network Manager where appropriate and as business needs demand
    • Performs other duties as assigned

    Qualifications

    What you can bring to Meridian:

     

    • Bachelor’s degree or equivalent experience required
    • At least 5-8 years of industry experience with emphasis on Network Management administrative and operational activities of a Pharmacy Benefit Management (PBM) organization is required
    • Strong understanding of prescription claims processing and pharmacy provider industry
    • Proficiency within Microsoft Word and Microsoft Excel
    • Ability to operate effectively and efficiently on complex, fast-paced projects
    • Ability to collect and analyze information, problem-solve, and make decisions
    • Ability to meet established deadlines while utilizing project management skills
    • Ability to have strong attention to detail and follows through on all aspects of assigned tasks and responsibilities
    • Ability to adapt to regularly changing rules, regulations and industry standards

    What MeridianRx can offer you: 

     

    • Healthcare benefits that include a variety of plans, which are effective on the first day of employment for our new full-time team members.   
    • Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.  
    • 401k matching that is above the national average.   
    • Full-time MeridianRx employees are eligible for tuition reimbursement towards Bachelor’s or graduate degrees.  
    • A bright and engaging company culture; the Meridian family of companies has been recognized as one of Metro Detroit’s Best and Brightest Companies to Work For 5 years in a row.   

     

                                                                           Equal Opportunity Employer 

    #MSTR 

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