Pharmacy Data Coordinator
Neugen LLC Madison, WI
- Expired: over a month ago. Applications are no longer accepted.
Pharmacy Data Coordinator
The Pharmacy Team Coordinator provides data and process analysis, utilization management and project support to the Pharmacy Team to ensure executive of department and Company priorities.
% of Time
• Data and Process Analysis:
- Support tasks related to tracking Medical Loss Ratio (MLR).
- Generate reports for pharmacy benefit, medical benefit drug spend and trend and MLR impact.
- Gather reported plan performance metrics from vendors for medical specialty, high-performing network pharmacies, oncology program and all pilot programs.
- Review and analyze current departmental processes, systems, work queues and satisfaction surveys to diagnose and identify the root cause of workflow, quality gaps and suggest recommendations to resolve.
- Assist leadership in developing long and short-term solutions to business needs, such as training, process improvement and application management
- Create, maintain and distribute intradepartmental quality, productivity and process metrics.
- Provide regular reporting to leadership on key performance indicators (KPI's), productivity, areas of risk and authorization data.
- Prepare and finalize completed audit data reports for configuration and operations management.
- Assist the manager in developing and maintaining a process for monitoring and tracking process/system changes to ensure business needs are met.
- Reconcile vendor invoices.
• Utilization Management:
- Review and process pharmacy prior authorizations using a prescribed process to fully reconcile to end-result determination.
- Make updates with MedImpact formulary to websites, guidelines, portal and appropriate internal contacts.
- Maintain Benefit Code listing spreadsheet for internal department(s).
- Coordinate updates for Medical Specialty Drug Coverage Audit (MSDCA) with Policy Administration Committee (PAC), guidelines, Code Reference Tool (CRT), website, etc.
- Maintain pharmacy list for internal department(s) including updating when drugs are added/removed and communication with internal teams.
- Process coverage determinations ensuring they are processed to the end result of accurate and timely posting, notification and pushed through proper committees for review, configuration and approval, PAC review, configuration and website listing.
- Facilitate accurate communication to Customer Service for use in guidelines and provide pharmacy benefit communications to internal business units as changes in the pharmacy benefits are made.
• Project Management:
- Provide support for team projects such as preparing status reports and providing feedback to the project team as necessary.
- Participate in project efforts across the enterprise on formal and informal project teams.
- Participate in the roll-out of new projects/products to the department to ensure procedures are efficient and effective.
- Coordinate eligibility file and assist with correcting errors.
- Manage data extracts by taking project work directives and initiating Business Service Requests (BSR) to generate data extracts and distribute to stakeholders.
This job description describes the general nature and scope of responsibilities for this position. Please note other duties and responsibilities may be assigned or removed at any time.
• Minimum Associate’s Degree , Business or related field or commensurate experience.
• 2 to 4 years of experience at a pharmacy, health insurer or Pharmacy Benefit Manager including working knowledge of structure and function of pharmacy benefits.
• Working knowledge of how medical drug claims are processed beginning with coverage determinations, configuration and updating website for formula end exclusions.
• Proficient with all Microsoft programs including word, excel, database management, power point, etc.
• Knowledge of pharmacy and drug benefit on medical side in order to function in prior authorization space of pharmacy medical utilization management.
• Verbal and written skills, including ability to handle angry, difficult, or unreasonable callers, communicate persuasively, explain technical issues, and make group presentations; and the ability to compose clear, concise correspondence, internal policies and procedures, presentations, publications, newsletters, training materials, and narrative reports.
• Ability to analyze issues and resolve problems within the scope of the position.
• Ability to understand priorities of the department and work with the team to ensure execution on all elements.
• Ability to work independently and to establish, monitor, and achieve goals with minimal supervision.
• Ability to develop and maintain effective, collaborative relationships with customers, stakeholders, and staff at all levels of the organization.
• Ability to be composed and adaptive in a dynamic, fast-paced, customer-focused work environment characterized by rapid change, minimal lead times, and multiple competing priorities.
• Ability to work in typical office conditions with frequent use of computer equipment.
PREFERRED QUALIFICATIONS AND SKILLS
• SQL experience.
Reasonable accommodations may be made to enable individuals with qualifying disabilities to perform the essential functions of the position.