Medical Coding Specialist

Capital Rx; New York (NY); On-site; USD 70,000 - 85,000; Full time

Job summary

Judi Health in New York, NY is seeking a licensed Pharmacy Technician to support formulary maintenance and operationalize client formulary requests within our adjudication platform.

You will triage Salesforce cases, assist with claims troubleshooting, and help develop marketing materials and job aids while collaborating with cross-functional teams.

Qualifications

• Registered Pharmacy Technician license required.
• Certification from PTCB or NHA preferred.
• 3-4 years of pharmacy experience in a health plan or PBM.

Responsibilities

• Support weekly, monthly, and quarterly maintenance and QA checks of standard and custom formularies for all lines of business.
• Assist pharmacists in operationalizing 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 and supports testing by uploading adjudication data to Salesforce cases.
• Assist pharmacists with cross-functional support for claim troubleshooting via adjudication platform.

Skills

Pharmacy technician license

PBM knowledge

Excel advanced

Large dataset experience

Pharmacy claims terminology

Education

Pharmacy technician certification (PTCB/NHA)

PBM experience

Tools

Microsoft Excel

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.