Formulary Admin Specialist I

Formulary Admin Specialist I

Requirements

• 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
• Good working knowledge of Microsoft Office Suite (Word/Excel/Outlook)
• Current Pharmacy Technician License and/or CPhT certification without restriction preferred

Responsibilities

• 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
• 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
• 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
• 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

Preferred Qualifications

• 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