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

• 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 clients 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
• 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.
• Other duties as assigned.

Supervisory Responsibilities

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; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.

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

Education and/or Experience

Associate’s degree and 2+ years’ experience or equivalent combination of education and experience

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.

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 detailed but uninvolved written or oral instructions.  Ability to deal with problems involving a few concrete variables in standardized situations.

Mathematical Skills

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

Language Skills

• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. 

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

• Composure
• Decision Quality
• Organizational Agility
• Problem Solving
• Customer Focus
• Drive for Results
• Peer Relations
• Time Management
• Dealing with Ambiguity
• Learning on the Fly
• Political Savvy

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 accommodation 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 regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 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 accommodation may be made to enable individuals with disabilities to perform the essential functions.

This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic).

Work Location

This position works on-site at the San Diego Headquarters or other company location (or from a remote location with management approval based on business requirements). Must provide adequate support to internal clients; be available for regular interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as be available to facilitate effective decisions through collaboration with stakeholders.

Working Hours

This is a full-time non-exempt position requiring one to be able to work overtime from time to time 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.

Travel

This position requires no travel; however attendance may be required at various local conferences and meetings.

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.