Location: George Rd, Tampa, FL 33634
Department: Pharmacy - State & Benefit Relations
Reports to: Sr. Director, Pharmacy Benefit Relations
Oversees the pharmacy programming has been set-up accurately by the PBM and thus serving as additional layer of QA and testing for PBM delegated functions relating to claim adjudication and plan set-up. Ensures all coding has been done appropriately while also reviewing system generated outputs to validate outcomes. The position is also responsible for oversight of all PBM data interfaces ensuring control points are in place to confirm delivery & receipt of files, that files are accurate and complete, and that mapping of data fields is correct, resulting in a high degree of confidence that the PBM is performing all duties appropriately.
- Oversees the pharmacy programming has been set-up accurately by the PBM and thus serving as additional layer of QA and testing for PBM delegated functions relating to claim adjudication and plan set-up.
- Requires an in-depth knowledge of the RxCLAIM PBM software to ensure all coding has been done appropriately while also reviewing system generated outputs to validate outcomes.
- Responsible for reviewing all PBM coding, including formulary and plan set-ups, network coding - including not only validation of all programming requests sent to the PBM but also constant coding updates performed by the PBM relating to the plan set-ups and configurations.
- Serves as the point of contact for all PBM coding issues identified internally by other departments so that pre validation can be performed
- Responsible for oversight of all PBM data interfaces ensuring control points are in place Articulates and present business analysis results clearly and concisely to programming staff.
- Creates and Analyzes Pharmacy Reports and Data Files in support of the Pharmacy Benefit Relations team.
- Conducts / assists with Pharmacy Benefit and related systems/files testing as necessary.
- Performs special projects as assigned.
- Required: High School or GED
- Preferred: Bachelor's Degree in Business, Computer Science or related field
- Required: 2 years of related experience in Healthcare, Managed Care, Pharmacy, PBM, and/or Information Systems
- Preferred: 2 years of related experience in systems analysis and data analysis
- Preferred: 2 years of experience with SQL, SAS, or similar
- Strong oral and written communication skills to effectively communicate clearly with people both within and outside the organization.
- Ability to read, analyze, and interpret general business documents, policies and procedures or technical procedures.
- Ability to write reports, business correspondence and training documents.
- Ability to effectively present information and respond to questions from Pharmacy Management and Pharmacy Technicians.
- Ability to interpret a complex variety of technical instructions, and deal with several abstract and concrete variables.
- Experience with RxCLAIM, PBM Systems or Pharmacy Systems Preferred
- Ability to work in a fast paced environment with changing priorities
- Demonstrated analytical skills
- Microsoft Excel
- Microsoft Access
- Microsoft Outlook
- Microsoft PowerPoint
- Microsoft Word
- Oracle Database Management System (DBMS)