Clinical Coding Consultant Pharmacist - Remote
About The Position
The Clinical Pharmacist on the Clinical Coding Consulting team serves as the primary liaison between OptumRx’s Formulary & Utilization operations, Benefit Operations Management and the Clinical Consultant. The role provides clinical coding support for OptumRx clinical consultants, benefit operations management (BOM), information technology, and other internal departments. This individual is relied upon to provide custom formulary & utilization management coding consultation & work to the clinical consultant client facing teams on formulary & utilization management set up in the RxClaim adjudication system & related formulary management applications. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Requirements
- Bachelor of Science in Pharmacy or PharmD
- Current and unrestricted Pharmacist license (any U.S. state)
- 2+ years of experience working as a Clinical Consultant or Clinical pharmacist working in Formulary/UM operations or Benefit administration
- Experience conducting claims/coding research and analysis
- Experience working within a PBM
- Experience working in RX Claim or other claims adjudication system
- Ability to navigate MS Office and a Windows based environment and the ability to create, edit, save, and send documents utilizing Microsoft Word; ability to navigate Outlook and conduct Internet searches
- Intermediate to Advanced Proficiency with Microsoft Excel
Nice To Haves
- MBA or other related advanced business degree
- Experience using Microsoft Access or other database/query tools
- Experience with Medi-Span drug classification system
- Client-facing experience (beyond patients and prescribers)
Responsibilities
- Provides consultative guidance for standard & custom formulary changes in RxClaim, RxBuilder & related clinical applications (RxAuth, RxInteract)
- Conducts 2ND Level Formulary/UM Claim Research
- Implementation clinical coding support for BDS/cBDT/RxConstruct questions
- GPI Reclass support/global Coding Change Support Drug utilization management
- Commercial clinical audit support
- Manage custom formulary coding work post client sign off
- Translate client intent to code-able language for BOM team
- Evaluate / resolve new rule design & conflicts with existing formulary coding
- New Client Implementation coding support for custom formulary/UM programs
- Extracts, evaluates and interprets clinical coding in adjudication & formulary management systems
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
