Formulary Administration Specialist I

Exemption Status:

“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

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Weekly Drug Updates for Commercial clients

• Reviews weekly drug update projects, participate and assist in weekly formulary maintenance
• Attends Client meetings
• Monitors/updates Drug Rules and Auto coding rules per client requests
• Researches and responds to client inquiries; escalates to managers/pharmacists for complex issues
• Weekly Drug Updates for Medicare Part D formularies.
• Reviews weekly drug update projects, and participate and assist in weekly formulary maintenance
• Researches and responds to client inquiries; escalates to managers/pharmacists for complex issues

• Formulary mailbox and salesforce cases management

• 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 salesforce case queries.

• Monthly and Pre-Plan Year ASCII Submissions

• Uploads CMS status tracking and responses, updates version numbers within Formulary Service’s database
• Processes and distributes formulary ASCII submissions files to clients
• Uploads ASCII files to Health Plan Management System (HPMS)for standard formularies collaborating with the assigned pharmacist;

• Negative Formulary Changes Process

• Enters negative formulary changes request into formulary platform tool for standard formularies;  
• Uploads and submits negative changes request into HPMS for Standard formularies;
• Processes and performs quality control for “Future Formulary Change Files” and distribute to clients for website posting;  

• Formulary Pre-plan Year Process

• Reviews with the client the Formulary Implementation Questionnaire (IQ) and clarifies any questions/issues;
• Builds the formulary framework based on the client’s implementation questionnaire for review by pharmacists;

• Prepare basic formulary parameters (rules) into the spreadsheet, this includes “temporary” or “special coding”; 
• Provides audit support for claims analysis and sending client communications
• Performs Prior Authorization (PA) processing as needed during times of staffing shortages or absences.

• 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.

Supervisory Responsibilities                                             

This job has 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: Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients; Manage difficult client situations.

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 accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience                                            

Associate's degree or Certified Pharmacy Technician CPT (or equivalent combination of education and experience required). Bachelor’s degree preferred. At least 1+ year pharmacy (or) 1+ year PBM industry experience working with Medicare Part D and Prior Authorization.

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 preferred.

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 apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

Mathematical Skills                                                 

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, ratios, area, circumference, and volume.  Ability to apply concepts of basic algebra.

Language Skills

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.  Ability to write routine reports and correspondence.  Ability to speak effectively to customers and employees of organization.

Competencies                                              

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

• Technical Skills - Assesses own strengths and weaknesses; Pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others.

• Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.

• Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.

• Motivation - Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles; Measures self against standard of excellence; Takes calculated risks to accomplish goals.

• Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.

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 accommodations 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 frequently required to use hands to finger, handle, or feel. The employee is occasionally required to stand; walk and reach with hands and arms. The employee must occasionally lift and/or move up to 10 pounds.

Work Environment

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

The noise level in the work environment is usually moderate.

Working Hours

This is a non-exempt position requiring one to be able to work overtime occasionally in order to get the job done.  Therefore, one must have the ability to work nights, weekends or on holidays as required.  This may be changed at any time to meet the needs of the business.  The typical working hours for this position are Monday through Friday from 8:00am to 5:00pm.

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

To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers

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.