Cardinal Health Managed Care Administrator in Houston, Texas

Cardinal Health Innovative Delivery Solutions

With over 45 years of experience in helping hundreds of hospital and outpatient pharmacies, we provide access to best practice strategies and tactics to control costs, improve workflow and enhance safety. Cardinal Health Innovative Delivery Solutions is one of the largest employers of acute-care pharmacist in the United States. Cardinal Health is the employer of choice for pharmacists because we offer a variety of career opportunities in pharmacy leadership, clinical specialties, remote order entry, business management, medication therapy management and more.

Managed Care Administrator:

Responsibilities :

1. Acquire retail pharmacy distribution contracts for pharmacies and 340B contracts for clinic

  • Interface with pharmacy distribution for contracts or amendments
  • Interface with IT to setup 340B accounts for clinics

2.. Obtain Order Express Accounts

3. Enroll pharmacies in ISF Products: LeaderNet, Prescription Club, MedSync, Recon+, Reimbursement Consulting Service, Prescription editing

4. Enroll pharmacies in third party payer or managed enrollment programs: CIGNA, Caremark, Express Scripts, Humana, Medicaid, Medicare and other payer and discount card programs

5. Provide managed care helpdesk support which could involve the following tasks:

  • Accept calls from pharmacy to assist in completing claims

- Work with Processor to determine issue

- Work with Cerner to insure proper setup

- Work with switch to improve profitability, implement/manage formularies, manage edits

  • Work with accounting to investigate and review rejected or under-paid claims
  • Suggest edits and third party set-up improvements to maximize profitability of claims

6. Maintain important pharmacy documents including contracts, leases, and managed care agreements or amendments

7. Maintain database of important pharmacy identifiers including various permits, license numbers, account numbers

8. Provide centralized communications to CHC pharmacies:

  • Distribute managed care notices
  • Publish weekly dashboard data
  • Publish helpful managed care claims processing tips
  • Coordinate internal meetings and conference calls
  • Coordinate registration and travel for external meetings or conferences

Location:

  • Houston, Texas – position will work from Cardinal Health’s Houston, Texas Enclave Parkway office

Reports to :

  • Director, Client Experience Team

Position Requirements:

1. Understanding of retail managed care claims including:

  • Prescription requirements
  • Claims Edits
  • Claims reconciliation process (835 files)
  • SureScripts e-prescribing
  • Switch capabilities
  • NCPDP D.0 File layout
  • NCPDP D.0 Reject code

2. Familiarity of retail pharmacy management systems

3. Working knowledge of Microsoft Office software applications

4. Knowledge of HIPAA privacy and security requirements

Interpersonal Skills :

1. Excellent communication skills with friendly outlook

2. Detail oriented, organized and disciplined view towards work

3. Ability to work independently with minimal direct supervision

4. Exercises strategic thinking and planning

5. Ability to recognize a sense of urgency when a situation presents

6. Ability to set priorities and respond quickly to emergency requests

Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.