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WellCare - Pharmacy Support Careers

Pharmacy Formulary Coordinator Job

Full Job Title: Pharmacy Formulary Coordinator, Sr.

Job Number: 1704653

Location: Tampa, FL

Date Posted: 10-31-2017

Department: Pharmacy - Formulary
Reports to: Manager Formulary Pharmacy
Location: 4110 George Road, Tampa FL 33634

Coordinates and controls the workflow occurring in and out of the department. Tracks and reviews the development and maintenance of the Medicare formularies, Medicaid Preferred Drug Lists (PDL's) and all coding changes sent to the Pharmacy Benefit Manager (PBM) by line of business. Partners closely and coordinates with other pharmacy and functional departments on a frequent basis to ensure synergies and cross-departmental effectiveness.


Key Duties and Responsibilities

• Reviews and tracks all aspects of pharmacy claims processing and formulary management for completeness and coding accuracy. (i.e. Medispan information and changes sent to PBM for coding)

• Develops and maintains Medicare Formularies and Medicaid Preferred Drug Lists, PDLs.

• Audits the formularies and PDL's to ensure the terms of agreement have been loaded accurately.

• Serves as the department's audit lead for claims research, analytics, and support (i.e. Acumen, TMPA, CMS program audit, rebate audits).

• Works with channel and digital communications for all Medicare comprehensive formularies and Notice of Change website postings to maintain CMS compliance.

• Under the direction of a pharmacist, handles formulary medical / drug related questions from the WellCare call center and ensures formulary and preferred drug list changes have been communicated to internal partners.

• Supports Formulary leadership on initiatives, tasks and projects related to all aspects of the plans' pharmacy benefit for all lines of business (e.g. Medicare, PDP, Medicaid).

• Researches and resolves routine provider operational issues with internal and external partners.

• Troubleshoots claims issues with internal and external partners.

• Oversees the weekly and monthly receipt of Third Party Vendor files.

• Completes ongoing test claims and claim review for PBM oversight and logic analysis.

• Pulls daily reports from the log review for tracking and trending, and alerts the vendor account manager to ongoing issues.

•Serves as SME for pharmacy PDL and formulary related issues.

• Facilitates in-service education sessions for technicians on formulary changes and preferred drug lists and for coordinators on PBM coding updates.

• Supports manager with onboarding and training of new coordinators.

• Maintains tools Step Actions and Job Aids.

• Maintains PBM activity and error logs to measure accuracy of Medicare and Medicaid coding.

• Performs special projects as assigned or directed.

State the minimum required for the job
Education Level Education Details Required/Preferred
An Associate's Degree in a related field Required
or equivalent work experience Additional 1 year experience in a managed care environment with a focus on formulary, PBM, or pharmacy operations. Required
A Bachelor's Degree in a related field Preferred
Work Experience
State the minimum required for the job
Experience Level
5 years of experience in working as a pharmacy technician, PBM, or in claims related roles Required
Licenses and Certifications
List professional licenses and certifications associated with this job
Licenses/Certifications Other Licenses/Certifications Required/Preferred
Certified Pharmacy Technician (CPhT) Preferred
State the minimum required for the job
Ability to communicate and make recommendations to upper management Intermediate
Ability to effectively present information and respond to questions from peers and management Intermediate
Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions Intermediate
Ability to work in a fast paced environment with changing priorities Intermediate
Ability to represent the company with external constituents Intermediate
Ability to work within tight timeframes and meet strict deadlines Advanced
Demonstrated interpersonal/verbal communication skills Intermediate
Demonstrated organizational skills Intermediate
Knowledge of healthcare delivery Intermediate
Other ability to mentor, train and teach others Intermediate
List technical skills associated with the job
Technology Other Technology Proficiency Required/Preferred
Microsoft Excel Intermediate Required
Microsoft PowerPoint Intermediate Required
Microsoft Outlook Intermediate Required
Healthcare Management Systems (Generic) Advanced Required

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Last Updated On: 12/9/2015