Pharmacy Benefits Specialist I
About The Position
The Pharmacy Benefits Specialist I provides basic operational, planning, implementation, and reporting support for Network Health Plan’s Pharmaceutical Benefits area. The role provides administrative support, builds report queries, maintains operational and financial reports, researches and resolves claim-processing and benefit issues, serves as a technical resource for internal users regarding pharmacy benefits, and maintains pharmacy formularies in written and web formats. Candidates must reside in Wisconsin. The position uses a hybrid workplace model, combining work from a home office (reliable internet required) with work at the office. The role is 1.0 FTE, 40 hours per week, Monday through Friday, 8:00 a.m. to 5:00 p.m.
Requirements
- High school diploma or equivalency required.
- One year of experience in a Pharmacy Technician position or one year of experience working with pharmacy benefits required.
- Candidates must reside in Wisconsin.
Nice To Haves
- Certified Pharmacy Technician preferred; one year of experience working with pharmacy benefits may substitute for certification.
Responsibilities
- Manage large mailings, including letter preparation, mail merge, and distribution.
- Create and maintain Prescription Benefit Summary of Member Responsibility tables.
- Provide reports for internal and external stakeholders, including prior authorization, physician utilization, controlled substance reporting, the Annual Quality Improvement Program Evaluation, call logs, drug reports related to the Key Performance Indicator Board, and standard reports from the Pharmacy Benefits Manager (PBM) in collaboration with Sales.
- Complete file reviews for denials.
- Maintain J-Code Tier Levels billing tables for claims.
- Answer formulary status questions for Commercial and Medicare Sales and Customer Service.
- Assist Care Management and Disease Management with benefit questions, prior authorization requirements, and grievances.
- Pull data for reporting pharmacy trends.
- Manage the PBM Satisfaction Survey process.
- Research and resolve benefit issues.
- Conduct benefit testing.
- Perform other duties and responsibilities as assigned.
Benefits
- Opportunity to volunteer in a local neighborhood while being paid.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
