Serves in direct support to the Director of Pharmacy Benefit Relations as a liaison between WellCare and it's Pharmacy Benefit Manager (PBM) for all aspects of pharmacy claims processing issues. The Pharmacy Benefit Relations Coordinator is responsible for pharmacy claims processing issue resolution and follow-up with the PBM, where appropriate. The individual will also serve as the primary point of contact between the escalated Pharmacy call center support staff and the PBM for issues that require intervention and resolution with the PBM. The individual is also responsible for coordination and support during audits relating to pharmacy claims processing, specifically surrounding information gathering and analytical evaluation of preliminary audit results. The results would be expected to be communicated to the Director of Pharmacy Benefit Relations to call out where potential issues and gaps may be with the compiled audit results.
Report to: Manager, Pharmacy Benefits Relations
Location: Independence Rd/George Rd
Type: Hourly/ Non-Exempt
- Serves as primary point of contact to the escalated Pharmacy call center support staff on PBM issues.
- Escalates issues to the PBM account team, where appropriate, and seeks follow-ups, as necessary until resolution
- Supports the Director of Pharmacy Benefit Relations on a wide array of adhoc tasks relating to the PBM
- Responsible for manual updating of the PBM eligibility to sync up with WellCare enrollment systems on a daily basis where updates are not made available through batch loading in the PBM system.
- Responsible for making updates in the PBM system as part of Medicare Part D PDE reconciliation.
- First tier point of contact for information gathering in audits relating to pharmacy claims processing, including audits by state and federal agencies.
Education: High School Diploma. A Bachelor's Degree is preferred, but not required.
Experience: 2 years experience in pharmacy or managed care.
Licenses/Certifications: Certified Pharmacy Technician is preferred, but not required.
Special Skills (e.g. 2nd language): none
Technical Skills/Requirements: Proficient in Microsoft Office including Excel and Power Point