Pharmacy Systems Coordinator

Independent Health Association•Buffalo, NY

3d•$22 - $25

About The Position

The Pharmacy Systems Coordinator is responsible for maintaining all pharmacy systems to allow Pharmacy Benefit Dimensions (PBD) to accurately adjudicate prescription claims against the pharmacy benefits of its members and provide accurate pharmacy information to all stakeholders. Responsibilities include, but are not limited to, benefit designs, claims payment, eligibility issues, researching and resolving inquiries, assist with training associates, and updating documentation for all lines of business. Occasional evenings, weekends, holidays and overtime are a requirement of the position.

Requirements

High School diploma or GED required.
Three (3) years of pharmacy experience required.
Strong interpersonal, written and verbal communication skills.
Strong Microsoft Office skills required.
Experience with Microsoft Office applications, and demonstrated ability to learn new software application.
Proven examples of displaying the PBD values: Trusted Advisor, Innovative, Excellence, Guardianship, Dedication and Caring.

Nice To Haves

One (1) year of experience as a PBD Pharmacy Systems Assistant may be considered in lieu of three (3) years pharmacy experience requirement.
Significant and detailed knowledge and experience with RxClaim™ and associated systems is preferred.
Experience in report production, and the ability to maximize use of system capabilities to lead the organization in outcome improvement.

Responsibilities

System Administration and Maintenance: Assist with maintenance of RxClaim functionality as it pertains to all lines of business. Attend assigned MOD review meetings, test and/or review SR’s assigned for MOD implementation and assist with installation tasks on MOD night. Communicate problem defects to Pharmacy Systems Specialist along with detailed documentation and associated testing scenarios. Ensure reliable interfacing with the HealthRules system, and other support systems. Responsible for maintenance of the RxAuth application.
Benefit and Formulary Administration: Build benefit plans in the RxClaim system to ensure pharmacy claims process according to the design of the product. Responsible for assigned primary or secondary testing for all plan builds or updates, including tests to confirm administration accuracy and consistency. Maintain and follow the documented drug change process for formulary updates within set time frames and with accuracy within the policy. This includes reporting issues or questions to the Pharmacy Systems Specialist. Responsible for the maintenance of all eligibility files for all lines of business, including but not limited to updating person codes, dual eligible members, UOI updates, staging/loading files, and updating monthly eligibility logs. Provide support and assist with process improvements. Participate in any ad-hoc projects as needed.
Claims Management and Payment: Responsible for daily review of the payment process in RxClaim, including but not limited to reviewing reports and resolving any associated issues. Monitor and validate claims for processing accuracy. Participate as the Detective of the Day to handle help desk issues. Escalate all unresolved issues to the Pharmacy Systems Specialist. Also responsible for build and testing of new pharmacies, pharmacy pricing and QA-ing client pricing. Complete processing of file loads needed for claims management. Assist with any ad-hoc projects as needed.
Training and Documentation: Assist with the creation or revision of all training documentation, policies and procedures. Ensure that documentation accurately reflects system functionality, industry best practices, and are appropriate, current, and well organized. Also accountable for the training and mentoring of associates.