Formulary Administration Specialist

MedImpact Healthcare Systems, Inc.; United States; Remote; USD 61,000 - 101,000; Full time

Benefits offered by this job

Medical / Dental / Vision / Wellness 

Paid Time Off / Company Paid Holidays

Incentive Compensation

401K with Company match

Life and Disability Insurance

Tuition Reimbursement

Employee Referral Bonus

Job summary

MedImpact Healthcare Systems, Inc. seeks a Formulary Administration Specialist I to join our team in the United States.

You will participate in design and validation of pharmacy benefit management plans and ensure accurate coding of plan information into formulary systems while supporting external clients with formulary change requests. This role emphasizes customer service, data accuracy, and collaboration with pharmacists and managers; prior PBM knowledge and pharmacy tech license preferred;

Qualifications

• Associate's degree and 2+ years' experience or equivalent combination of education and experience.

Responsibilities

• The Formulary Administration Specialist I participates in the design and validation of pharmacy benefit management plans.
• Ensures accurate coding of plan specific information into formulary systems and provides support to external clients relating to formulary change requests.
• Ensures service levels meet corporate standards for performance and quality.

Skills

Customer service

PBM knowledge

Detail oriented

Multitasking

Education

Associate's degree and 2+ years' experience

Tools

Microsoft Office Suite

Job description

Exemption Status:

United States of America (Exempt)

$60,987 - $80,808 - $100,628

"Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate."

This position is not eligible for Sponsorship.

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!

Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!

Job Description

Summary

The Formulary Administration Specialist I participates in the design and validation of pharmacy benefit management plans. This position ensures accurate coding of plan specific information into formulary systems and provides comprehensive support to external clients related to formulary change requests. Ensures appropriate service levels are maintained to meet corporate standards for performance and quality.

Essential Duties and Responsibilities

include the following.

Drug Updates for Commercial Clients

• Review weekly/monthly/quarterly drug update projects.
• Prepare weekly/monthly/quarterly formulary files for pharmacist review.
• Monitors/updates Drug Rules and Auto-Coding rules.
• Research and respond to client inquiries; escalates to managers/pharmacists for complex issues.

Formulary Mailbox and Client Management Platform

• Triages inquiries; serves as a resource for troubleshooting basic issues; escalates to managers/pharmacists for complex issues.
• Drafts client communication to be reviewed by management; customizes templates with client instructions including clarification of roles/responsibilities between MedImpact and the client; prepares routine client responses to email and case queries.

Negative Formulary Changes Process

• Compile member disruption reports for pharmacist review.
• Review member letters before letters are distributed.

Formulary Process

• Build formulary shells with pharmacists.
• Provide claims analysis support.
• Works to gain a solid understanding of Formulary and PBM operations through on-the-job training, in-house educational opportunities and related external seminars or coursework.

Other duties as assigned.

Supervisory Responsibilities

No supervisory responsibilities

Client Responsibilities

This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written). One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

Associate's degree and 2+ years' experience or equivalent combination of education and experience.

Computer Skills

To perform this job successfully, an individual should have a good working knowledge of Microsoft Office Suite (Word/Excel/Outlook) and good familiarity working with databases.

Certificates, Licenses, Registrations

Current Pharmacy Technician License and/or CPhT certification without restriction.

Other Skills and Abilities

• Basic PBM knowledge, Drug Information and Prior Authorization experience preferred;
• Familiarity with National Drug Data Provider products a plus;
• Medicare Part D formulary knowledge desired;
• Good written/verbal communication skills; good interpersonal skills as well as the ability to work cohesively with a team;
• Must be able to juggle multiple priorities; follow through to completion on all tasks and be detail oriented

Reasoning Ability

• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Mathematical Skills

• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Language Skills

• Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
• Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

Competencies

To perform the job successfully, an individual should demonstrate the following competencies:

Composure

Decision Quality

Organizational Agility

Problem Solving

Customer Focus

Drive for Results

Peer Relations

Time Management

Dealing with Ambiguity

Learning on the Fly

Political Savvy

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Ability to maintain clear near visual acuity at approximately 20 inches or less (i.e., "close vision") to accurately read fine print, view computer screens, and handle small objects. Requires adequate color vision and depth perception to support safety and precision in detail-oriented tasks.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes, or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic).

Work Location

This position works on-site at the San Diego Headquarters or other company location (or from a remote location with management approval based on business requirements). Must provide adequate support to internal clients; be available for regular interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as be available to facilitate effective decisions through collaboration with stakeholders.

Working Hours

This is an exempt level position requiring the incumbent to work the hours required to fully accomplish job responsibilities and meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required. Work hours may be changed from time to time to meet the needs of the business. Typical core business hours are Monday through Friday from 8:00am to 5:00pm.

Travel

This position requires domestic travel of up to 5% of the time.

The Perks

• Medical / Dental / Vision / Wellness Programs
• Paid Time Off / Company Paid Holidays
• Incentive Compensation
• 401K with Company match
• Life and Disability Insurance
• Tuition Reimbursement
• Employee Referral Bonus

MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.

Equal Opportunity Employer, Male/Female/Disabilities/Veterans

OSHA/ADA

To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.