Kansas Works Jobs

Overview of Position Manage the pharmacy claims processing application change management process and systems configuration for the Ohio Medicaid client which generally includes: User Story creation, ticketing, systems configuration, user acceptance testing, documentation of test results, post production verification, and business rule management.

• File Loads

• Weekly drug file

• Prioritize client systems changes and guide them through the change management process

• Account NCPDP transaction set expert

What will be my duties and responsibilities in this job?

• Responsible for all system configuration and maintenance of all configuration elements including but not limited to: Edits, PDL, OTC Formulary, utilization management, and automated prior authorization criteria

• Accountable for testing all configuration changes and ensuring that the testing is complete, expected results were achieved and that the test case documentation and results are put into an approved format for review by ODM

• Responsible for reviewing editorial information received from drug database Contractor on at least a weekly basis to determine if any configuration changes are required

• Responsible for trouble-shooting any claims processing related issues

• Responsible for management of procedures associated with system related change requests

• Responsible for ensuring the integrity of the pharmacy data used in claims processing

• Responsible for developing and maintaining Claims Processing related system documentation and business procedures manual(s)

• Responsible for serving as informational resource for call center regarding claims processing

• Responsible for serving as informational resource pertaining to inquiries, system configuration, and data files/extracts; and

• Support and back-up of Account Manager and Service Desk Manager, as appropriate.

What are the requirements needed for this position?

• Be a full-time employee

• Have 2+ years' pharmacy claims experience

• Have a minimum of three (3) years of experience with Medicaid or large private sector pharmacy benefits manager

What other skills/experience would be helpful to have?

• Demonstrated knowledge of drug data elements published by drug compendia/databases

• Demonstrated expertise with offeror’s claims processing system and how business rules are to be configured efficiently, and

• Demonstrated knowledge of pharmacy claims transaction sets.

What are the working conditions and physical requirements of this job?

• General Office Duties

• Remote office with high-speed dependable internet.

How much should I expect to travel?

• Possibility of up to 20% travel

  Employees in roles that require travel will need to be able to qualify for a company credit card or be able to use their own personal credit card for travel expenses and submit for reimbursement.

  Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!

  COVID Vaccination Requirements

  We remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. As such, we require all employees to disclose COVID-19 vaccination status prior to beginning employment and we may require periodic testing for certain roles. In addition, some roles require full COVID-19 vaccination as an essential job function. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance.

  Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to applyaccommodations@changehealthcare.com with "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted to this email box will not be accepted.

Click here https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf to view our pay transparency nondiscrimination policy.

California (US) Residents: By submitting an application to Change Healthcare for consideration of any employment opportunity, you acknowledge that you have read and understood Change Healthcare’s Privacy Notice to California Job Applicants Regarding the Collection of Personal Information (https://www.changehealthcare.com/privacy-notice/privacy-notice-to-california-job-applicants) .

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.

Change Healthcare is an equal opportunity employer. All qualified applicant will reveive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status.