Formulary Operations Specialist

Capitalrx; Denver (CO); On-site; USD 70,000 - 85,000; Full time

Job summary

Judi Health in Denver, CO seeks a Pharmacy Technician with 3–4 years of PBM experience to support formulary maintenance, client requests, and data adjudication. You will triage cases in Salesforce and assist with QA and testing of formulary updates.

The role requires an active Pharmacy Technician license, strong Excel skills (including VBA/macros), and the ability to manage multiple tasks in a fast-paced environment. Equal opportunity employer.

Qualifications

• 3–4 years of pharmacy experience in a health plan or PBM.
• Formulary development and maintenance experience at a PBM or health plan.
• Proficient in Microsoft Excel, including advanced functions and macros (VBA).
• Experience working with large datasets.
• Knowledge of pharmacy claims processing and terminology.
• High attention to detail.

Responsibilities

• Support maintenance and QA checks of formulary for Commercial/Medicaid/Medicare Part D and HIM.
• Assist pharmacists in implementing client formulary and benefit requests in the formulary management platform.
• Triages and assists with Salesforce cases for custom formularies.
• Triages and monitors the Formulary Operations inbox.
• Uploads formulary composites and supports testing by uploading adjudication data to Salesforce.
• Assist pharmacists with cross-functional claim troubleshooting via adjudication platform.
• Review testing output templates for formulary accuracy.
• Create and maintain client/formulary marketing materials and SharePoint sites.
• Execute data-entry for adjudication system maintenance; inputs inactive-to-active NDC updates.

Skills

Attention to detail

Independent worker

Problem solving

Education

Pharmacy Technician license

CPHT or NHA certification

Tools

Excel (Advanced)

Job description

About Judi Health

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:

• Judi Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,
• Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and
• Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.

Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health.

Position Responsibilities

• Support the weekly, monthly, and quarterly maintenance and quality assurance checks of standard and custom formularies for all lines of business including Commercial, Medicaid, Medicare Part D, and the Health Information Marketplace
• Assists the pharmacists in operationalizing nd implementing custom client formulary and benefit requests within the formulary management and adjudication platform
• Triages and assists with Salesforce cases for custom formularies
• Triages and monitors the Formulary Operations inbox
• Uploads formulary composites in the adjudication platform and supports Benefits team testing by uploading adjudication data to applicable Salesforce cases
• Assists the pharmacists with cross functional support for claim troubleshooting through the adjudication platform
• Reviews formulary testing output templates for formulary accuracy
• Supports the creation, maintenance, and validation of client and formulary marketing materials in the formulary management tool
  • Conducts adjudication system maintenance data entry activities
  • Inputs inactive to active NDC updates
  • Supplemental list updates in Medispan for pharmacists to perform quality checks
  • Creates non-formulary tier flips in the formulary management tool
  • Performs weekly formulary updates for Liberty, Freedom, and standard HIM formularies
  • Weekly moratorium updates, and weekly utilization management updates in the formulary management tool
  • Performs Monthly Specialty formulary updates in the formulary management tool
• Provides support to Weekly New Drug to Market updates
• Assists with creating job aids for Formulary Operations
• Develops and maintains departmental SharePoint sites
• Completes assigned work plan objectives and projects on a timely basis
• Ensures quality assurance and formulary accuracy
• Support quality improvement projects, as required
• Support RFI and RFP submissions, as required
• Support general business needs and operations, as required
• Responsible for adherence to the JudiRx Code of Conduct, including reporting of noncompliance
• Performs other duties and responsibilities as needed

Required Qualifications

• Registered Pharmacy Technician license
• Certification from the National Pharmacy Technician Certification Board or National Health Career Association or equivalent experience
• 3-4 years of pharmacy experience working for a health plan or PBM
• Formulary development and maintenance process experience at a PBM or health plan including experience with custom client benefit and formulary design highly preferred
• Proficient in Microsoft office suite with emphasis on Microsoft Excel including advanced Microsoft Excel functions, VBA, macros, etc.
• Experience working with large datasets required
• Knowledge of pharmacy claims processing drug names, and pharmacy/medical terminology
• High attention to detail required
• Ability to work independently and accurately in a fast-paced environment
• Flexible, highly organized, and able to shift priorities easily
• Ability to balance multiple projects simultaneously
• Commitment to delivering a high-quality work product

Denver, CO Salary Range: $70,000 — $85,000 USD

All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non‑compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.