Formulary Admin Specialist I

MedImpact Healthcare Systems, Inc.•San Diego, CA

21h•Onsite

About The Position

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team! Our success is dependent on innovative professionals with top-notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare. At MedImpact, we deliver leading-edge pharmaceutical and technology-related solutions that dramatically improve the value of healthcare. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!

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) and good familiarity working with databases.
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 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 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.
Composure
Decision Quality
Organizational Agility
Problem Solving
Customer Focus
Drive for Results
Peer Relations
Time Management
Dealing with Ambiguity
Learning on the Fly
Political Savvy

Nice To Haves

Bachelor’s degree preferred.
Current Pharmacy Technician License and/or CPhT certification without restriction preferred.
Basic PBM knowledge, Drug Information and Prior Authorization experience preferred;
Familiarity with National Drug Data Provider products a plus;
Medicare Part D formulary knowledge desired;

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
Reviews weekly drug update projects, and participate and assist in weekly formulary maintenance
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.