Medical Coding Specialist

Capital Rx; Charlotte (NC); On-site; USD 70,000 - 85,000; Full time

Job summary

Judi Health seeks a Pharmacy Technician to join the Formulary Operations team, supporting weekly to quarterly maintenance of formularies for Commercial, Medicaid, Medicare Part D and Health Information Marketplace. You will assist pharmacists, triage Salesforce cases, and manage adjudication data in the formulary management tool from our Charlotte, NC location.

The role requires a registered Pharmacy Technician license and 3–4 years in pharmacy with PBM/health plan experience; proficiency in

Qualifications

• Licensed Pharmacy Technician (registered)
• Experience with PBM/health plan formulary processes preferred
• Proficient in handling large datasets and pharmacy terminology

Responsibilities

• Maintain and QA standard and custom formularies across lines of business
• Assist pharmacists in operationalizing client formulary requests in the adjudication platform
• Triages Salesforce cases for formularies and monitors the Formulary Operations inbox
• Upload formulary data in adjudication platform and test with Benefits team
• Support claim troubleshooting through the adjudication platform
• Create job aids and maintain SharePoint sites
• Ensure formulary accuracy and participate in QA projects

Skills

Pharmacy operations

Microsoft Excel

Data analysis

Education

Certified Pharmacy Technician

Tools

Microsoft Office

Excel VBA

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
• Performs other duties and responsibilities as needed

Required Qualifications:

• Registered Pharmacy Technician license
• Certification from theNationalPharmacy 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 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

New York, NY Salary Range $70,000—$85,000 USD

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

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 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 athttps://www.judi.health/legal/privacy-policy.