Pharmacy Operations Support Specialist Open to Pharm Benefits Coordinator level

4 weeks ago

Des Moines, Iowa, United States Wellmark Full time

About the Role:

We are seeking a highly organized and efficient Pharmacy Operations Support Specialist to join our team at Wellmark. As a Pharmacy Operations Support Specialist, you will provide support to the Pharmacy team by coordinating, researching, and resolving inquiries through multiple channels.

You will provide technical and administrative support to various teams, including Customer Service, Sales, and other internal departments. Your responsibilities will include assisting with recurring administrative functions necessary to update and maintain the pharmacy programs and formulary for Wellmark.

This includes, but is not limited to, partnering with Pharmacy team members and other internal teams to identify impacted members, update drug lists, perform quality review of benefits, and analyze decisions to determine the effectiveness of the program.

About You:

We are looking for a strong communicator, both verbally and in writing, who is skilled in effectively educating others on processes and procedures. You should be a self-starter with strong organizational skills and the ability to independently balance priorities in a fast-paced, dynamic environment.

You should be proficient with Microsoft Office and have a technical aptitude to learn new software quickly. Additionally, you should have excellent decision-making and problem-solving abilities, as well as strong interpersonal skills with the ability to build relationships of collaboration and trust with different business areas.

Responsibilities:

  • Research and respond to inquiries; support other Pharmacy Team members with complex inquiries.
  • Assist Pharmacy Analyst - UM & Formulary with developing and maintaining code sets for all therapeutic classes with UM programs.
  • Identify member disruptions resulting from formulary or UM changes, benefit changes, and new group implementations.
  • Assist Clinical Pharmacy Team and Pharmacy Analyst - UM & Formulary with keeping the formulary web tool, benefit drug lists, and drug policies on the web up to date.
  • Manage independent review organization (IRO) requests for a non-formulary drug intake process and coordinate member and provider communications as a result of IRO decisions.
  • Perform outreach calls to members, pharmacies, and providers related to IRO decisions.
  • Communicate with members and providers that results in accurate understanding of IRO request outcomes.
  • Apply member engagement philosophies and personality-based resolution techniques to all interactions.
  • Work in coordination with internal teams in reviewing and updating Frontier Knowledge articles as needed in accordance with regulatory requirements, BCBSA guidelines, and other internal processes as needed.

Requirements:

  • HS diploma or GED.
  • 1+ year of related pharmacy operations work experience from within managed care, health care, pharmacy, PBM, customer service, or similar environment.
  • Experience should reflect knowledge of pharmacy practice (e.g., drug name, NDC, GPI), pharmacy claims processing and/or UM tools (e.g., formulary, prior authorization, step therapy).
  • Ability to proactively develop professional customer relationships by listening, understanding, anticipating and responding with solutions to customer needs.
  • Knowledge of applicable regulatory standards, accreditation standards and internal guidelines (e.g., NCQA or UM standards); remain current and consistent with the standard pertinent to pharmaceuticals.
  • Effective critical thinking and analysis skills. Ability to evaluate information and implement appropriate solutions.
  • Strong written and verbal communications skills with the ability to clearly and concisely communicate complex concepts with internal and external stakeholders.
  • Excellent decision making and problem solving abilities.
  • Strong interpersonal skills with the ability to build relationships of collaboration and trust with different business areas.
  • Proficiency with Microsoft Office. Technical aptitude to learn new software quickly.
  • Self-starter with strong organizational skills and the ability to independently balance priorities in a fast-paced, dynamic environment.
  • Additional Required Qualifications for Pharmacy Benefits Coordinator level: Associate's degree or direct and applicable work experience. Experience with systems analysis or testing to include writing and executing test cases. Knowledge of drug coding and concepts (i.e. NDC, GPI, J codes, MediSpan, etc.). Ability to perform, document, and or guide others through a series of related steps and takes action to improve existing conditions and processes.

What We Offer:

Wellmark is an equal opportunity employer and offers a competitive salary and benefits package. We are committed to creating a diverse and inclusive work environment and encourage applications from qualified candidates from diverse backgrounds.

How to Apply:

To apply for this role, please submit your resume and cover letter to [insert contact information]. We look forward to hearing from you

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