Responsibilities
- Reviews weekly drug update projects, participate and assist in weekly formulary maintenance
- Attends Client meetings
- Monitors/updates Drug Rules and Auto coding rules per client requests
- Researches and responds to client inquiries; escalates to managers/pharmacists for complex issues
- Triages inquiries; serves as a resource for troubleshooting basic issues; escalates to managers/pharmacists for complex issues
- Drafts client communication to be reviewed by management; customizes templates with client instructions including clarification of roles/ responsibilities between MedImpact and the client; prepares routine client responses to email and salesforce case queries
- Uploads CMS status tracking and responses, updates version numbers within Formulary Service’s database
- Processes and distributes formulary ASCII submissions files to clients
- Uploads ASCII files to Health Plan Management System (HPMS)for standard formularies collaborating with the assigned pharmacist
- Enters negative formulary changes request into formulary platform tool for standard formularies
- Uploads and submits negative changes request into HPMS for Standard formularies
- Processes and performs quality control for “Future Formulary Change Files” and distribute to clients for website posting
- Reviews with the client the Formulary Implementation Questionnaire (IQ) and clarifies any questions/issues
- Builds the formulary framework based on the client’s implementation questionnaire for review by pharmacists
- Prepare basic formulary parameters (rules) into the spreadsheet, this includes “temporary” or “special coding”
- Provides audit support for claims analysis and sending client communications
- Performs Prior Authorization (PA) processing as needed during times of staffing shortages or absences
- Works to gain a solid understanding of Formulary and PBM operations through on-the-job training, in-house educational opportunities and related external seminars or coursework
Requirements
- Associate's degree or Certified Pharmacy Technician CPT (or equivalent combination of education and experience required)
- At least 1+ year pharmacy (or) 1+ year PBM industry experience working with Medicare Part D and Prior Authorization
- Good working knowledge of Microsoft Office Suite (Word/Excel/Outlook)
- Good familiarity working with databases
- Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals
- Ability to write routine reports and correspondence
- Ability to speak effectively to customers and employees of organization
- Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, ratios, area, circumference, and volume
- Ability to apply concepts of basic algebra
- Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form
- Ability to deal with problems involving several concrete variables in standardized situations
- Ability to juggle multiple priorities
- Ability to follow through to completion on all tasks and be detail oriented
- Ability to work cohesively with a team
- Ability to respond promptly to client needs
- Ability to solicit client feedback to improve service
- Ability to respond to requests for service and assistance from clients
- Ability to meet commitments to clients
- Ability to manage difficult client situations
Nice to Have
- Bachelor’s degree
- Current Pharmacy Technician License and/or CPhT certification without restriction
- Basic PBM knowledge, Drug Information and Prior Authorization experience
- Familiarity with National Drug Data Provider products
- Medicare Part D formulary knowledge
- Good written/verbal communication skills
- Good interpersonal skills
Additional Information
- The employee is regularly required to sit and talk or hear.
- The employee is frequently required to use hands to finger, handle, or feel.
- The employee is occasionally required to stand; walk and reach with hands and arms.
- The employee must occasionally lift and/or move up to 10 pounds.
- The noise level in the work environment is usually moderate.
- This is a non-exempt position requiring one to be able to work overtime occasionally in order to get the job done. Therefore, one must have the ability to work nights, weekends or on holidays as required. This may be changed at any time to meet the needs of the business. The typical working hours for this position are Monday through Friday from 8:00am to 5:00pm.
- This position requires no travel however attendance maybe required at various local conferences and meetings.
