Pharmacy Support Specialist (Open to hiring at Sr level)

Wellmark, Inc.•Des Moines, IA

6h•Hybrid

About The Position

As a Pharmacy Support Specialist, you will provide support to the Pharmacy team by coordinating, researching, and resolving inquiries through multiple channels. You will provide technical and administration support to various teams (Customer Service, Health Services, Sales, etc.), and assist with reoccurring administrative functions necessary to update and maintain the pharmacy programs and formulary for Wellmark. This includes, but is not limited to, partnering with Pharmacy team members and other internal teams to identify impacted members, update drug lists, perform quality review of benefits, and analyze decisions to determine the effectiveness of the program.

Requirements

Pharmacy Support Specialist Level: HS diploma or GED.
Minimum of 1 year of related pharmacy operations work experience from within managed care, health care, pharmacy, PBM, customer service, or similar environment. Experience should reflect knowledge of pharmacy practice (e.g., drug name, NDC, GPI), pharmacy claims processing and/or UM tools (e.g., formulary, prior authorization, step therapy).
Ability to proactively develop professional customer relationships by listening, understanding, anticipating and responding with solutions to customer needs.
Knowledge of applicable regulatory standards
Effective critical thinking and analysis skills. Ability to evaluate information and implement appropriate solutions.
Strong written and verbal communications skills with the ability to clearly and concisely communicate complex concepts with internal and external stakeholders.
Ability to effectively resolve issues and conflicts in a professional manner while maintaining composure and confidence.
Strong interpersonal skills with the ability to build relationships of collaboration and trust.
Proficiency with Microsoft Office. Technical aptitude to learn new software quickly.
Self-starter with strong organizational skills and the ability to independently balance priorities in a fast-paced, dynamic environment. Flexible and adaptable to change.
Sr Level: Associate's degree or direct and applicable work experience.
Minimum of 2 years of related pharmacy operations work experience from within managed care, health care, pharmacy, PBM, customer service or similar environment. Experience should reflect knowledge of pharmacy practice (e.g., drug name, NDC, GPI), pharmacy claims processing and/or UM tools (e.g., formulary, prior authorization, step therapy).
Experience with systems analysis or testing to include writing and executing test cases.
Knowledge of drug coding and concepts (e.g. NDC, GPI, J codes, MediSpan, etc.).
Ability to perform, document, and or guide others through a series of related steps and takes action to improve existing conditions and processes
Ability to identify issues or inconsistencies; obtains relevant information, relates and compares data from different sources and identifies alternative solutions
Knowledge of applicable regulatory standards
Effective critical thinking and analysis skills. Ability to evaluate information and implement appropriate solutions.
Demonstrated, strong written and verbal communications skills with the ability to clearly and concisely communicate complex concepts with internal and external stakeholders.
Strong interpersonal skills with the ability to build relationships of collaboration and trust with different business areas. Viewed as a subject matter expert and go-to resource.
Strong collaboration skills, with the flexibility to adapt to different stakeholders
Proficiency with Microsoft Office, including Excel; use of pivot tables, charts, and formulas is preferred. Technical aptitude to learn new software quickly.
Self-starter with strong organizational skills and the ability to independently balance priorities in a fast-paced, dynamic environment. Flexible and adaptable to change.

Nice To Haves

Pharmacy Support Specialist Level: Associate’s degree.
Certified Pharmacy Technician.
Sr Level: Bachelor's degree.
Certified Pharmacy Technician.

Responsibilities

Manage appeals on formulary exception denials (independent review organization-IRO) requests for a non-formulary drug intake process and coordinate member and provider communications as a results of IRO decision.
Perform outreach calls to members, pharmacies, and providers related to IRO decisions. Provide value-based customer experience through active listening and responding accurately, promptly, and professionally to member and provider questions. Manage difficult conversations that result in escalated interactions with professionalism and composure.
Provide written communicate to members and providers that results in accurate understanding of IRO request outcomes.
Research and timely respond to pharmacy inquiries received from Customer Service, Case Management, or benefits/eligibility questions from Sales. Ensure research and response is clearly communicated by responding accurately, promptly, and professionally.
Responsible for the analysis and appropriate resolution(s) of pharmacy related inquiries and processing. Research, interpret and educate internal stakeholders or customer regarding the inquiry in question and then determine next steps required in order to accurately process pharmacy claims and outstanding questions.
Process updates to the website including formulary, benefit drug lists, and drug policy updates based on direction provided by the Clinical Pharmacists.
Submit request for updates in Facets for maintaining code sets for all therapeutic classes with UM programs.
Submit requests for updates to OpSource.
Identify trends, areas for improvement, or educational opportunities and escalate to leadership as appropriate.
Continuously develop and maintain a strong business acumen within Wellmark business, benefit designs, and pharmacy strategies and programs.
Other duties as assigned