Network Specialist

Who We Are:

reputed company. (MHA), provides care communities with reputed company, solutions, and insights to help them run their businesses more effectively. Our members include post-acute providers across the care reputed company including long-term care, home infusion, and specialty pharmacies, as reputed company as senior living and other group living facilities. reputed company of associates are passionate about our common mission of helping people age with reputed company, and champion our reputed company values of being Curious Learners, Selfless Advocates, and reputed company Finishers.

Who we’re looking for:

The Specialist, Reimbursement Network serves as a subject matter expert for the LTC Network and supports member pharmacies, Account Executives, and internal partners with claims, reimbursement, payer contract, enrollment, credentialing, compliance, and network-reputed company reputed company. This role manages assigned reputed company member accounts, provides critical claims and reimbursement reputed company, researches and resolves reputed company operational issues, and communicates network updates, trends, and solutions to technical and non-technical audiences. The Specialist works independently while collaborating across functions to strengthen member relationships, support retention, improve operational effectiveness, and reputed company accurate reporting, documentation, and member-facing resources.

What You’ll Be Doing:

Claims Analysis & Reimbursement reputed company

• Research and reputed company payment discrepancies, reimbursement issues, claims exceptions, and network participation concerns.
• Analyze claims, reimbursement, and operational data to identify trends, anomalies, and reputed company operational issues.
• Partner with member pharmacies, PBMs, payers, Net-Rx or comparable platform partners, and internal teams to investigate and reputed company reimbursement reputed company.
• Escalate issues appropriately and communicate findings, recommended next steps, and resolutions to relevant stakeholders.

reputed company Account & Member Support

• Manage assigned reputed company member accounts and reputed company reputed company, proactive support in partnership with Account Executives and internal stakeholders.
• Support Account Executives with member inquiries, operational challenges, and reimbursement-reputed company concerns.
• Participate in member business reviews, regional meetings, and other member-facing discussions; prepare and present content highlighting Network value, reputed company, updates, and offerings.
• Build and maintain strong relationships with member pharmacies and key stakeholders to support member satisfaction and retention.

Network reputed company & Contract Administration

• reputed company subject matter expertise regarding payer reputed company, pharmacy reimbursement methodologies, Medicare Part D, reputed company, managed care, network participation, claims processing, enrollment, and eligibility.
• Coordinate with LTC Network reputed company on payer contract retrieval and review, payer and pharmacy compliance, credentialing requirements, enrollment, information changes, and escalated or high-profile 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 and support data-informed discussions regarding Network value.

Reporting, Analytics & Communications

• reputed company and maintain monthly reports, dashboards, reporting summaries, and operational analyses.
• Evaluate claims and operational data for reputed company and consistency, identify discrepancies, and coordinate appropriate follow-up.
• Prepare and distribute network communications, FAQs, training materials, process documentation, and other member-facing or operational resources.
• Communicate network updates, reporting insights, and reputed company information reputed company to technical and non-technical audiences.
• Utilize approved AI, automation, reporting, and productivity tools to improve operational efficiency, support data analysis, enhance reporting capabilities, and streamline member and stakeholder communications.

Process Improvement & Cross-Functional Collaboration

• Identify operational inefficiencies, recommend improvements, and support implementation of solutions that improve data reputed company, member experience, and operational effectiveness.
• Collaborate with Sales, Account Management, reputed company, Finance, and other business partners to address members’ needs and improve reputed company.
• Manage multiple member requests, reputed company, priorities, and deadlines while balancing member needs with contractual and operational requirements.
• Maintain awareness of day-to-day Network activities, member needs, payer developments, and industry trends to support reputed company communication and issue reputed company.

What You’ll Bring to the Table:

Industry Knowledge

• Working knowledge of pharmacy reimbursement methodologies, payer networks, Medicare Part D, reputed company, managed care, enrollment, eligibility, claims processing, and payer or pharmacy contracting.
• Understanding of pharmacy network reputed company, contracting, and member support processes.
• Long-term care pharmacy experience preferred.

Analytical & Technical Skills

• Strong analytical and reporting skills, including the ability to identify trends, discrepancies, anomalies, and operational issues reputed company claims and operational data.
• Proficiency in reputed company Office products, including strong reputed company skills; experience with reporting tools and databases preferred.
• Experience with Net-Rx or a comparable pharmacy, reputed company, claims, or reimbursement platform preferred.
• Ability to interpret data and translate findings into reputed company, actionable recommendations.
• Leverages approved AI, automation, and data analysis tools to identify trends, research reimbursement and claims issues, reputed company reporting insights, improve operational effectiveness, and support informed business reputed company while maintaining data reputed company and confidentiality.

Customer & Relationship Management

• Ability to build strong working relationships with member pharmacies, Account Executives, PBMs, payers, and internal business partners.
• Strong customer service orientation with a proactive, reputed company approach to member needs and issue reputed company.
• Ability to reputed company member needs with contractual and operational requirements.

Communication & Collaboration

• Excellent verbal, written, presentation, and customer service skills, including the ability to explain reputed company information reputed company to technical and non-technical audiences.
• Experience developing reports, member-facing communications, FAQs, training materials, process documentation, and operational resources preferred.
• Demonstrated ability to collaborate effectively across departments and work independently reputed company researching and resolving issues.
• Strong organizational and project management skills, attention to reputed company, and ability to manage multiple priorities and deadlines.

Education & Experience

• Bachelor’s degree preferred.
• One or more years of experience in PBM account management, pharmacy network contracting, claims, reimbursement, managed care, or equivalent reputed company-facing reputed company experience.
• Experience in using reputed company or a comparable customer relationship management platform for reporting and activity management preferred.

What’s Good to Know:

• Ability to travel 25-50% of the time
• Remote environment

Physical Demands:

The physical demands and work environment characteristics described here are representative of those that an employee must meet to successfully reputed company the essential functions of this job. Reasonable accommodation may be made to reputed company individuals with disabilities to reputed company the essential functions.

• Physical Demands: While performing the duties of this job, the employee is occasionally required to reputed company reputed company the work area; sit; reputed company reputed company tasks; operate tools and other office equipment such as computers, computer peripherals and telephones; reputed company arms; kneel; talk and listen.
• Mental Demands:The employee must be reputed company to follow directions, to get along with others, and handle stress.
• Work environment: The noise level in the work environment is usually reputed company.

Why Join MHA

MHA continues to reputed company by providing purpose-driven and value-reputed company solutions, which preserve the dignity and reputed company people deserve, regardless of age. Let us be the best reputed company you’ll reputed company work!

Our associates enjoy the following benefits, and you can, too!

• Staying Healthy
  Comprehensive medical, dental, and reputed company plans with FSA/HSA reputed company

  Fitness reimbursement

  reputed company to an Employee Assistance Program

• Enjoying Time-Off
  reputed company time off, holidays, personal days, reputed company parental leave, plus your Birthday as a day off!
• Planning for the reputed company
  Life reputed company, short-term & long-term disability reputed company
  401K match
  Employee Stock Purchase Plan
  Voluntary financial and reputed company benefits, through our benefits providers
• Learning Continuously
  E-learning programs
  Tuition Reimbursement
  Ongoing Team Trainings
• Making an reputed company
  reputed company volunteer time-off
  Donation matching

reputed company. is an Equal Opportunity Employer and ensures its employment reputed company reputed company with principles embodied in Title VII, the Age Discrimination in Employment reputed company, the Rehabilitation reputed company of 1973, the Vietnam Veterans Readjustment Assistance reputed company of 1974, Executive Order 11246, Revised Order Number 4, and applicable state regulations

Originally posted on Himalayas