Pharmacy Benefit Coord-( PBM) SWHP
Location: Temple, Texas US
Requisition Number: 19015782
The Pharmacy Benefits Coordinator is responsible for specific lines of business, will lead clinical and compliance monitoring of all aspects of pharmacy benefit management (PBM) and operational areas, including claim adjudication, benefit analysis, pharmacy benefit implementation and documentation of monitoring. This position will lead workgroups and projects as assigned.
ESSENTIAL FUNCTIONS OF THE ROLE
The Pharmacy Benefits Coordinator will serve as a Subject Matter Expert (SME) for pharmacy benefit programs and operations and is responsible for urgent and complex adjudication and processing issues including research, analysis, identification of root cause, impact analysis and corrective action. The PB Coordinator interacts with vendors and internal stake holders to coordinate benefits, resolve access to care issues, operationalize clinical programs, and ensure compliance with the Health Plan and regulatory governing bodies. In addition, the PB Coordinator leads the implementation testing of new functionality, prepares test scenarios and executes testing.
KEY SUCCESS FACTORS
The ideal candidate must have knowledge of PBM operations, multiple clinical pharmacy resources, drug nomenclature, basic pharmacology, dosage calculations, units of measure, prescription filing and documentation, pharmacy laws, regulations, basic managed care and insurance coverage. The ideal candidate must have strong problem solving, critical thinking, technical and analytical skills, be proficient in Microsoft Office and related software programs, and have the ability to lead and delegate tasks, manage multiple priorities and develop relationships. A Certified Pharmacy Technician (CPhT) certification is preferred.
- Specialty/Department/Practice - BSWH- Southwest Health Plan - Temple, TX
- Shift/Schedule - Full time- Days
- Benefits - Our competitive benefits package includes Immediate eligibility for health and welfare benefits, 401(k) savings plan with dollar-for-dollar match up to 5%, Tuition Reimbursement, PTO accrual beginning Day 1. Please note, benefits may vary based upon position type and/or level.
- EDUCATION: Bachelor's degree or equivalent experience is required
- EXPERIENCE: 3+ Years of experience is required
Community / Marketing Title: Pharmacy Benefit Coord-( PBM) SWHP
Location_formattedLocationLong: Temple, Texas US
CountryEEOText_Description: We are an equal opportunity employer committed to ensuring a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. To view the most recent EEO is the Law Poster, click here.