Network Specialist

Job not on LinkedIn

🔥 13 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🛜 Network Engineer / Network Administrator

🚫👨‍🎓 No degree required

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Managed Health Care Associates, Inc.

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1989

💼 Consulting

📦 Logistics

🍽️ Food & Beverage

Consulting • Logistics • Food & Beverage

Managed Health Care Associates, Inc. is a healthcare services and software company that helps alternate-site health care providers manage costs, improve operational efficiencies, and grow their businesses. It provides group purchasing for pharmaceuticals, medical products, business products and food service; pharmacy operating software; rebate processing; prior authorization and reimbursement solutions; data analytics and benchmarking; clinical consulting and software; and legislative affairs and vaccine buying group services for long-term care pharmacies, senior living, specialty and infusion pharmacies, home medical equipment providers and other alternate site care providers.

📋 Description

• Research and resolve payment discrepancies, reimbursement issues, claims exceptions, and network participation concerns • Analyze claims, reimbursement, and operational data to identify trends, anomalies, and complex operational issues • Partner with member pharmacies, PBMs, payers, Net-Rx or comparable platform partners, and internal teams to investigate and resolve reimbursement matters • Escalate issues appropriately and communicate findings, recommended next steps, and resolutions • Manage assigned strategic member accounts and provide responsive, proactive support with Account Executives and internal stakeholders • Participate in member business reviews, regional meetings, and member-facing discussions; prepare and present Network value, performance, updates, and offerings • Build and maintain relationships with member pharmacies and key stakeholders to support satisfaction and retention • Provide subject matter expertise on payer contracts, reimbursement methodologies, Medicare Part D, Medicaid, managed care, network participation, claims processing, enrollment, and eligibility • Coordinate payer contract retrieval and review, compliance, credentialing, enrollment, information changes, and escalated member issues • Manage pharmacy LTC Network enrollment activities, demographic and information changes, payer information, credentialing, and compliance requirements • Identify opportunities for member pharmacies to use additional MHA Network Services • Develop and maintain monthly reports, dashboards, reporting summaries, and operational analyses • Evaluate claims and operational data for accuracy and consistency and coordinate follow-up on discrepancies • Prepare and distribute network communications, FAQs, training materials, process documentation, and member-facing resources • Use approved AI, automation, reporting, and productivity tools to improve efficiency, analysis, reporting, and communications • Identify operational inefficiencies, recommend improvements, and support implementation of solutions • Collaborate with Sales, Account Management, Operations, Finance, and other business partners • Manage multiple member requests, projects, priorities, and deadlines • Maintain awareness of Network activities, member needs, payer developments, and industry trends • Travel 25-50% of the time

🎯 Requirements

• Working knowledge of pharmacy reimbursement methodologies, payer networks, Medicare Part D, Medicaid, managed care, enrollment, eligibility, claims processing, and payer or pharmacy contracting • Understanding of pharmacy network operations, contracting, and member support processes • Strong analytical and reporting skills, including identifying trends, discrepancies, anomalies, and operational issues within claims and operational data • Proficiency in Microsoft Office products, including strong Excel skills • Ability to interpret data and translate findings into clear, actionable recommendations • Ability to build strong working relationships with member pharmacies, Account Executives, PBMs, payers, and internal business partners • Strong customer service orientation with a proactive, responsive approach to member needs and issue resolution • Excellent verbal, written, presentation, and customer service skills • Ability to explain complex information clearly to technical and non-technical audiences • Demonstrated ability to collaborate effectively across departments and work independently • Strong organizational and project management skills, attention to detail, and ability to manage multiple priorities and deadlines • One or more years of experience in PBM account management, pharmacy network contracting, claims, reimbursement, managed care, or equivalent client-facing healthcare experience • Ability to travel 25-50% of the time • Bachelor’s degree preferred • Long-term care pharmacy experience preferred • Experience with reporting tools and databases preferred • Experience with Net-Rx or a comparable pharmacy, healthcare, claims, or reimbursement platform preferred • Experience developing reports, member-facing communications, FAQs, training materials, process documentation, and operational resources preferred • Experience using Salesforce or a comparable customer relationship management platform preferred

🏖️ Benefits

• Comprehensive medical, dental, and vision plans with FSA/HSA options • Fitness reimbursement • Access to an Employee Assistance Program • Paid time off, holidays, personal days, paid parental leave, plus your Birthday as a day off • Life insurance • Short-term and long-term disability insurance • 401K match • Employee Stock Purchase Plan • Voluntary financial and legal benefits through benefits providers • E-learning programs • Tuition reimbursement • Ongoing team trainings • Paid volunteer time-off • Donation matching • Remote environment