Apply on Employer Site

MedImpact Healthcare Systems, Inc. · 2 weeks ago

Formulary Admin Specialist I

San Diego, CA

Full-time

Onsite

Entry Level

$22.99/hr - $37.71/hr

1+ years exp

MedImpact Healthcare Systems, Inc. is seeking a Formulary Admin Specialist I to join their team. The role involves managing drug updates, responding to client inquiries, and assisting in formulary maintenance to enhance healthcare outcomes.

Health CarePharmaceutical

No H1B

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

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

Qualification

Pharmacy Technician LicenseMedicare Part D experiencePrior Authorization experienceMicrosoft Office SuitePBM knowledgeDrug InformationInterpersonal skillsTime ManagementProblem SolvingCustomer Focus

Required

Associate's degree or Certified Pharmacy Technician CPT (or equivalent combination of education and experience required)

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) and good familiarity working with databases

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

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

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

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

Preferred

Bachelor's degree preferred

Current Pharmacy Technician License and/or CPhT certification without restriction preferred

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

Benefits

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

Company

MedImpact Healthcare Systems, Inc.

Glassdoor2.8

MedImpact is the nation’s largest independent health solutions and pharmacy benefit company, serving commercial health plans, government programs, self insured/employer groups, and millions of consumers.

Founded in 1989

San Diego, California, USA

1001-5000 employees