Pharmacy Benefit Coordinator Temple or Austin
Company: Baylor Scott & White Health
Location: Killeen
Posted on: April 2, 2021
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Job Description:
JOB SUMMARY
The Pharmacy Benefit Coord serves in a key role in the development,
implementation and management of comprehensive and effective
pharmacy programs and benefits. Leads clinical and compliance
monitoring of all aspects of pharmacy benefit management (PBM) and
operational areas, including claim adjudication and benefit
analysis, pharmacy benefit implementation and documentation for
specific lines of business. Leads workgroups and projects as
assigned.
ESSENTIAL FUNCTIONS OF THE ROLE
Acts as a Subject Matter Expert (SME) for specific lines of
business as related to pharmacy benefit programs and
operations.
Responsible for urgent and complex adjudication and processing
issues including research, analysis, identification of root cause,
impact analysis and corrective action, partnering with vendor
through resolution.
Conducts moderate to complex data analysis including creating the
reports and pulling the data while providing regularly scheduled
reporting and communication to management.
Responsible for implementing and ensuring accuracy of pharmacy plan
designs and clinical programs.
Routinely interacts with vendors and internal stakeholders to
coordinate benefits, resolve access to care issues, operationalize
clinical programs, and ensure compliance with standards defined by
the Health Plan and regulatory governing bodies.
Responsible for education and training of staff regarding pharmacy
benefit requirements, processes and key projects, promoting best
practices.
Leads implementation testing of new functionality to ensure desired
outputs. Prepares test scenarios and executes testing. Assists with
development of report mapping and generates required data reports
for audits.
Responsible for review of standard and ad-hoc reports to confirm
compliance with Health Plan, regulatory and accreditation
standards, address gaps and ensures sound operations. Assists with
preparation for and serves as subject matter expert in audits
conducted by regulatory and accreditation bodies.
Interprets and accurately applies regulatory requirements that are
applicable to the job function.
KEY SUCCESS FACTORS
Certified Pharmarcy Technician (CPHT) preferred.
Ability to lead and delegate tasks through other team members.
Demonstrated ability to manage multiple priorities and deadlines in
a fast-paced environment.
Problem-solving, critical thinking skills and attention to detail a
must.
Well-organized and self-directed individual who is able to work
with minimal amount of supervision.
Sound technical skills and analytical ability, advanced ability to
apply reasoned judgment, and strong operational focus.
Advanced proficiency in Microsoft Office and in a variety of
industry related software programs.
Knowledge of PBM operations, formulary management and utilization
management edits preferred.
Knowledge of drug nomenclature, basic pharmacology, dosage
calculations, units of measure, prescription filing techniques,
prescription documentation requirements, pharmacy laws and
regulations, basic managed care principles and insurance coverage
issues.
Knowledge of multiple clinical pharmacy resources.
Ability to interact and maintain professional working relationships
with internal and external partners to coordinate benefits and
services.
Demonstrates professional business acumen including attendance,
adherence, attitude and behavior.
BENEFITS
Our competitive benefits package includes the following
- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level
QUALIFICATIONS
- EDUCATION - Bachelors or Equivalent Exp
- EXPERIENCE - A minimum of 3 years experience required
Keywords: Baylor Scott & White Health, Killeen , Pharmacy Benefit Coordinator Temple or Austin, Healthcare , Killeen, Texas
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