Description Responsible for, but not limited to, the planning and timely coding of edits, as requested by State, to the Contractor’s system that provide services to the State client, quality control of such edits to ensure proper functioning within the system, and ensuring that newly entered system changes and edits do not affect existing edits within Contractor’s system causing unanticipated adverse system events affecting any PBM Program claims, enrollees or Providers.
The System Liaison shall be responsible for all testing of new programs or modules to be used by Contractor to manage PBM Programs and shall also be responsible for the maintenance and management of Contractor’s website that serves all PBM Programs, including updating PDL changes, changes to clinical criteria, and other website changes, such as but not limited to, drug reimbursement changes updates.
The Configuration Manager will be responsible for all system configurations and the maintenance of all elements including but not limited to: edits, preferred drug list (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. Responsible for reviewing editorial information received from the drug database contractor on at least a weekly basis to determine if any configuration changes are required. 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 trouble-shooting any claims processing related issues. Responsible for developing and maintaining claims processing related system documentation and business procedures manual(s). The Configuration Manager is the informational resource for the call center regarding claims processing and is responsible for serving as informational resource pertaining to inquiries, system configuration, and data files/extracts. Will support and back-up the Account Manager and Service Desk Manager, as appropriate. Requirements EXPERIENCE
Minimum of three years experience with Medicaid or a large private sector pharmacy benefits manager. Bachelor's degree in Computer Science, Engineering or relevant field. Preferred: pharmacy technician or have equivalent relevant work experience in both pharmacy environments and office environments; must have excellent organizational skills, clerical skills and the ability to multi-task. Demonstrated knowledge of drug data elements published by drug compendia/databases. Demonstrated expertise with claims processing systems and how business rules are configured. Demonstrated knowledge of NCPDP transaction sets. Demonstrated knowledge of CMS rules, regulations, and guidance regarding Medicare and Medicaid.
Requisition Number 17-0278