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Medicare Pharmacy Benefits Specialist

2 months ago

Phoenix, Arizona, United States Blue Cross Blue Shield of Arizona Full time


Recognized as a Healthiest Employer, Blue Cross Blue Shield of Arizona is dedicated to its mission of promoting health and simplifying access to healthcare.

AZ Blue provides a comprehensive range of health insurance solutions tailored to meet the varied needs of individuals, families, and businesses of all sizes, while also offering resources and tools to empower individuals in making informed health choices.


JOB PURPOSE

  • Assist in the management of Blue Cross Blue Shield of Arizona's Medicare pharmacy benefits and initiatives, including but not limited to all Medicare Part D, Part B, and standalone Prescription Drug Plan programs.
  • Facilitate both internal and external support functions that enhance all Medicare programs endorsed by BCBSAZ.
  • QUALIFICATIONS
  • Required Experience:
  • Minimum of 1 year as a Pharmacy Technician, either internally or externally to Blue Cross.
  • At least 1 year of experience in a Medicare Advantage or PDP setting.
  • Experience in the Medicare pharmacy or medical sectors (e.g., pharmacy, health insurance, medical office).
  • Experience in Medicare Pharmacy Prior Authorization Intake & Processing.
  • Experience with Specialty Pharmacy reviews, including Medical Reviews.
  • Required Education:
  • High school diploma or GED.
  • Required Licenses:
  • Arizona State Pharmacy Technician License and National Certification (CPhT).
  • Preferred Qualifications:
  • Previous experience in the healthcare sector, particularly in a Pharmacy Benefit Manager (PBM) role.
  • Additional relevant education and/or experience is advantageous.
  • Analytical experience is a plus.
  • Essential Job Functions:
  • Support vendor oversight activities to ensure compliance regarding pharmacy claims, coverage determinations, and reporting.
  • Assist in improving Medicare Quality and STAR measures, which may involve direct interaction with Medicare members and network providers regarding pharmacy-related issues.
  • Contribute to compliance efforts, including fraud prevention, internal audits, and CMS program audits.
  • Maintain productivity standards for internal program support and outreach initiatives.
  • Offer recommendations for process improvements that enhance quality, compliance, and operational efficiency.
  • Incorporate quality improvement principles into various activities and projects.
  • Actively participate in departmental initiatives.
  • Generate accurate internal and external reports, providing summaries to departmental and divisional leadership.
  • Build and maintain relationships with business partners to strategize on the advancement of Medicare programs.
  • Utilize analytic platforms to analyze data for reporting purposes.
  • Perform all tasks in accordance with established policies, procedures, and professional standards.
  • Deliver exceptional service to all customers by consistently demonstrating core behaviors.
  • This position requires a full-time commitment, defined as working a minimum of 40 hours per week, plus additional hours as necessary.
  • Job involves extensive sitting with occasional standing and walking, along with significant use of personal computers and office equipment.
  • Effective communication skills are essential for reading, writing, and speaking in person or via telephone.
  • May require travel as needed.
  • Other duties as assigned.
COMPETENCIES
  • Required Skills: Proficient in PC applications, including word processing and spreadsheets.
  • Ability to lift up to 20 pounds.
  • Professional Competencies: Ability to foster relationships with internal and external customers.
  • Strong interpersonal skills are essential.
  • Effective communication skills are required.
  • Leadership Competencies: Utilize team members' skills to achieve business objectives.
  • Focus team activities using available information to identify priorities.
PREFERRED COMPETENCIES
  • Preferred Skills: Advanced proficiency in PC applications.
  • Bilingual in Spanish is a plus.
  • Preferred Professional Competencies: Strong interpersonal communication and multicultural sensitivity.
  • Experience with pharmacy vendor software and claims systems.

Our Commitment: Blue Cross Blue Shield of Arizona is an equal opportunity employer and does not discriminate based on race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, or any other protected group.