Formulary Operations Specialist

Judi Health; United States; On-site; USD 70,000 - 85,000; Full time

Job summary

Judi Health in Charlotte, NC is seeking a Pharmacy Technician to support formulary maintenance and QA across Commercial, Medicaid, and Medicare lines. You will assist pharmacists in operationalizing client formulary requests within our adjudication and formulary management platforms, triage Salesforce cases, and upload data for testing.

The role requires a licensed pharmacy technician with PBM experience, strong Excel/VBA skills, and the ability to work independently in a fast-paced environment

Qualifications

• Registered Pharmacy Technician license required.
• Certification from NPhCB or NHA or equivalent experience.
• 3-4 years of pharmacy experience with a health plan or PBM.
• Formulary development and maintenance experience at PBM/health plan; custom client benefits preferred.
• Proficient in Excel with advanced functions, VBA and macros.
• Experience working with large datasets.
• Knowledge of pharmacy claims processing and terminology.
• High attention to detail and ability to work independently in a fast-paced environment.
• Flexible, highly organized, and able to balance multiple projects.

Responsibilities

• Support weekly, monthly, and quarterly formulary maintenance and QA checks.
• Assist pharmacists in operationalizing client formulary/benefit requests within the formulary platform.
• Triages and assists with Salesforce cases for custom formularies.
• Triages and monitors the Formulary Operations inbox.
• Uploads formulary data in the adjudication platform and supports testing by uploading adjudication data.
• Assist pharmacists with cross-functional claim troubleshooting through the adjudication platform.
• Review formulary testing output templates for accuracy.
• Support creation/maintenance/validation of client and formulary marketing materials.
• Develop and maintain departmental SharePoint sites.
• Complete assigned work plan objectives and projects on time and maintain quality.

Skills

Attention to detail

Independent work

Multitasking

Data analysis

Education

Pharmacy Technician license

NPhCB or NHA certification

Tools

Microsoft Excel (advanced)

VBA

Macros

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:

• Supportsthe 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 casesfor 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 thepharmacists with cross functional support for claim troubleshooting through the adjudication platform
• Reviewsformulary testing output templates for formulary accuracy
• Supportsthe creation, maintenance,and validation of client andformulary marketing materialsin theformularymanagement tool
  • Conducts adjudication system maintenance data entry activities
  • Inputs inactive to active NDC updates
  • Supplemental list updates inMedispanfor pharmacists to perform quality checks
  • Createsnon-formulary tierflips in the formulary management tool
  • Performs weekly formulary updates for Liberty, Freedom, and standard HIMformularies
  • Weekly moratorium updates, andweekly utilization managementupdatesin the formulary management tool
  • Performs Monthly Specialty formulary updatesin the formulary management tool
• Provides support to Weekly New DrugtoMarket updates
• Assists withcreating jobaids for Formulary Operations
• Develops and maintains departmental SharePoint sites
• Completes assigned work plan objectives and projects on a timely basis
• Ensuresquality 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 theJudiRx Code of Conduct, including reporting of noncompliance
• Performs other duties and responsibilities as needed

Required Qualifications:

• Registered Pharmacy Technician license
• Certification from theNationalPharmacy Technician Certification Board or National Health career Association orequivalent 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 MicrosoftExcel 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 deliveringahigh-qualitywork product

Charlotte, NC Salary Range

$70,000—$85,000 USD

All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of noncompliance. 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.