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Pharmacy Benefits Strategist

1 month ago

Portland, Oregon, United States PacificSource Full time
Pharmacy Benefits Strategist

PacificSource is seeking a highly skilled Pharmacy Benefits Strategist to join our team. As a key member of our pharmacy team, you will be responsible for designing, implementing, and coordinating pharmacy program initiatives to support our members' access to quality, affordable care.

Key Responsibilities:
  • Provide oversight and quality assurance to ensure accurate setup of pharmacy benefit designs, formulary coding, network coding reporting, drug pricing, and claims analysis.
  • Collaborate with Sales, Product Development, and Pharmacy teams to ensure accurate and optimal pharmacy benefit designs and initiatives.
  • Support Sales team by generating and analyzing claims data, formulary comparisons, and projections for new and existing groups.
  • Manage interface between vendor/consultant/client to ensure efficient coordination and implementation of coding, including appropriate oversight and monitoring of all PBM operations, data interfaces, and external communications.
  • Support formulary administrators and leadership on initiatives, tasks, and projects related to all aspects of the plans' pharmacy benefit for all lines of business (Medicare, Medicaid, Commercial).
  • Perform ongoing drug and claim configuration setup and testing to ensure accuracy of point of service adjudication.
  • Provide claims research, analysis, and support during internal and external audits.
  • Research, troubleshoot, and resolve claims issues, along with review and documentation of service warranties.
  • Generate and analyze reports for new and transitioning groups.
  • Develop Pharmacy department policies and procedures as applicable and regular maintenance to reflect new best practices and guidance.
  • Organize, document, and support departmental performance dashboards.
  • Track and record drugs at launch for clinicians to make potential coverage and formulary decisions.
  • Support ongoing communication efforts, including member, pharmacy, and provider notifications.
  • Build reports in internal reporting software and performing accurate and complete data extraction from our data warehouse to support demands of pharmacy reporting, analysis, and projections.
  • Analyze medical and pharmacy claims to identify cost savings opportunities and process improvements and facilitate cross-departmental prioritization of pharmacy initiatives.
  • Present complex data, analysis, and findings to internal and external teams in a way that is clear and understandable.
  • Participate in special projects and committees.
Requirements:
  • Minimum of five years of experience within a healthcare field.
  • Preference for experience within managed care or pharmacy.
  • Preference for experience with Medicare Star ratings, Medicaid quality initiatives, and NCQA standards.
  • Preference for experience with Pharmacy benefit managers and project management.
  • Bachelor's degree required, with preference on degree in public health, healthcare-related, mathematics, statistics, data science, or similar research-related field, or equivalent years of relevant experience in lieu of degree.
  • Strong preference for certification in data software such as RxClaim, SQL, SAS, Excel, Tableau.
Competencies:
  • Adaptability
  • Building Customer Loyalty
  • Building Strategic Work Relationships
  • Building Trust
  • Continuous Improvement
  • Contributing to Team Success
  • Planning and Organizing
  • Work Standards
Environment:

Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.

Skills:
  • Accountability
  • Communication
  • Communication (written/verbal)
  • Flexibility
  • Listening (active)
  • Organizational skills/Planning and Organization
  • Problem Solving
  • Teamwork
Our Values:
  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for customer service.
  • We practice open communication at all levels of the company to foster individual, team, and company growth.
  • We actively participate in efforts to improve our many communities-internally and externally.
  • We actively work to advance social justice, equity, diversity, and inclusion in our workplace, the healthcare system, and community.
  • We encourage creativity, innovation, and the pursuit of excellence.