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Account Service Coordinator - IngenioRx Locations - PS26037

Anthem Atlanta, GA
  • Expired: over a month ago. Applications are no longer accepted.
Veterans Wanted

Your Talent. Our Vision . At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

Account Service Coordinator (Pharmacy/Managed Care) - Selected locations preferred #PS26037

The Account Service Coordinator is responsible for providing advanced customer service representation for Pharmacy Medicaid Operations. Partners with Pharmacy Medicaid Account team, Health Plans and Government Business teams to ensure operational excellence in meeting State contractual requirements.

Primary duties may include, but are not limited to:

  • Directs/manages administration of contractual requirements sand obligations
  • Be acclimated to Plan designs, benefits, clinical set-up, operational detains, as well as processes of the various accounts
  • Interprets and supports plan benefit design.
  • Resolves complex claims, benefit, and enrollment issues
  • Performs claims surveillance to confirm appropriateness of paid claims and identify any potential FWA issues
  • Reviews reject rules, PA rejections/denials, coordination of benefits, as needed, to ensure accurate and timely claim adjudication. Identifies trends that need attention and resolution to prevent future issues.
  • Interfaces with Health Plans, States, PBM, providers, and members with oversight by Account Management
  • Develops implementation processes and manages reporting processes to meet client retention /needs and high levels of Account satisfaction
  • Makes recommendations for improvements to meet customers' expectations
  • Responsible for being a contact and liaison for and between Anthem Medicaid Health Plan and PBM to assist in implementing and de-implementing client Rx benefits
  • Provides both on-site and off-site customer service , which may include interpreting Plan design, researching/resolving phone and written inquiries, resolving claims, benefit and enrollment issues.
  • Makes routine account and on-site facility visits. at frequencies deemed necessary by Pharmacy Manager
  • Coordinates, as the Pharmacy Medicaid Operations SME/internal partners, to ensure smooth delivery of services in accordance with contractual requirements/obligations
  • Works with multiple departments to ensure member needs are met for more complex issues; this includes claim processing, customer service, and account management. Other departments that one will interface with will include IT, analytics, membership, benefits
  • Will heavily partner with Anthem Rx Analytics team to better understand drivers of trend; analyze data and identify opportunities for operational improvement AND to drive Cost of Care savings strategies/initiatives to meet Medicaid Pharmacy and Organizational goals
  • Provides pharmacy expertise/leadership for new business launches, ACA expansions, and RFP detail regarding new/existing business opportunities
  • Provides strategic planning and contribute to departmental performance goals, including CoC targets, Pharmacy spend and trend targets and State customer/Health Plan satisfaction
  • Compiles information and supports pharmacy program updates to Leadership, including but not limited to: annual planning meetings, quarterly business reviews, biweekly trend meetings and ad-hoc business meetings.
  • Coordinates training sessions for Health Plans and rest of Regional team as new processes arise
  • Runs pharmacy reports and provides analysis to assist with projects implementations (i.e., claims report review during project go-lives)
  • Generates ad-hoc reports at the requests of Account Managers, State partners or Health Plans
  • Supports development of intranet content to improve the member/provider experience and team performance

  • Requires a BA/BS; minimum 3 years of related experience managing business operations and/or customer relationship which MUST include Pharmacy Benefit Manager (PBM) claims, customer service and/or membership experience in healthcare; or any combination of education and experience, which would provide an equivalent background.
  • Must have pharmacy experience
  • Pharmacy technician experience strongly preferred.
  • Must have managed care experience
  • Medicaid knowledge/experience preferred
  • Account Management experience preferred
  • Interpreting/supporting Plan benefit design experience preferred
  • PBM claims, benefits and enrollment experience required
  • Proficiency in MS excel, Power Point, Outlook
  • Proficiency and ability to focus on project management, tracking individual performance, as well as project performance
  • Superior organization and communication skills, able to compile a large volume of information and place in an easily understood and organized format for others to access
  • Some travel will be required including making routine account visits

  • Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran.



    Atlanta, GA