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Pharmacy
WellCare - Pharmacy Support Careers

Pharmacy Formulary Coordinator Job

Full Job Title: Pharmacy Formulary Coordinator

Job Number: 1705476

Location: Tampa, FL

Date Posted: 11-19-2017

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 coding issues and issue resolution for formulary and Preferred Drug Lists (PDLs). Partners closely and coordinates with other pharmacy and functional departments on a frequent basis to ensure synergies and cross-departmental effectiveness.

Essential Functions:
  • 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).
  • Ensures Medicare formulary and Medicaid PDL information is complete based on the requirements of the specific line of business.
  • Updates systems with formulary and preferred drug list changes in accordance to line of business and appropriate effective date timelines.
  • Maintains the integrity of the data loaded in to the Formulary Navigator tool for member and provider documents and website searches.
  • Performs ongoing claims testing to ensure accuracy of adjudication at Point of Service.
  • Researches, troubleshoots and resolves claims issues with internal and external partners.
  • Audits the formularies and PDL's to ensure the terms of agreement have been loaded accurately.
  • Provides claims research, analysis, and support during audits (i.e. Acumen, TMPA, CMS program audit, rebate audit)
  • Serves as the primary point of contact for the formularies and PDLs to various internal areas; escalating issues to the appropriate partners across the enterprise.
  • Elevates and regularly works with both internal and external partners regarding member calls concerning eligibility. (i.e. PBM, Pharmacy Help Desk, Customer Service).
  • Tracks requests coming into the department and evaluates trends; involving others as necessary.
  • Oversees the weekly and monthly receipt of Third Party Vendor files.
  • 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)
  • Follows all state and federal regulations and contractual requirements, including record retention requirements.
  • Performs other duties as assigned.
Additional Responsibilities:
MINIMUM QUALIFICATIONS
Education
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
Required
A Bachelor's Degree in a related field
Preferred


Work Experience
State the minimum required for the job
Experience Level
Experience Details
Required/Preferred
3 years of experience in
working in pharmacy technician, PBM or pharmacy 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


Skills
State the minimum required for the job
Skill Sets
Other Skills
Proficiency
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 influence internal and external constituents
Intermediate
Ability to work in a fast paced environment with changing priorities
Advanced
Ability to work within tight timeframes and meet strict deadlines
Advanced
Demonstrated analytical skills
Intermediate
Demonstrated interpersonal/verbal communication skills
Intermediate
Knowledge of healthcare delivery
Intermediate
Demonstrated organizational skills
Intermediate


Technology
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