Pharmacy Manager

Job Description

The Pharmacy Benefit Setup Auditor plays a crucial role in recognizing, interpreting, and evaluating discrepancies and inaccuracies in the pharmacy benefit set up data received. Their responsibilities include ensuring the timely and accurate configuration of our clients, adhering to defined audit / setup procedures, and actively participating in quality assurance processes. Proficiency in the internal systems of our contracted Pharmacy Benefit Managers (PBMs), as well as our own internal systems, is essential for this role. While direct interaction with external customers may not be involved, effective communication skills, the ability to manage tasks independently, and a knack for analytically resolving complex issues are vital traits. The individual must diligently follow process documentation to maintain accuracy while also leveraging critical thinking skills when required. Qualifications and Requirements: Bachelor’s degree (in Pharmacy preferred) 7+ years of related pharmacy/healthcare experience, medical auditing or coding experience is preferred Must possess analytical and critical thinking skill Proficient in English language skills both written and verbal Proficient in MS Office (Including Word, Excel, Outlook, SharePoint), advanced Excel skills (Macros, VLOOKUP, etc.) and basic Microsoft Access skills required Adept technically to use tools and techniques to suggest process enhancements Process minded individual with a strong attention to detail who understands the importance of following a consistent process to maximize efficiency & quality Demonstrated understanding of PBM, Payer and formularies and its relevance in Pharma business is strongly preferred A passion for learning and a willingness for taking on new challenges Must adapt well to change and successfully set and adjust priorities as needed Must be able to attend 6 weeks of new hire training that follows the US Central Standard Time (CST) time zone SalesForce experience is preferred Experience with reporting tools (QLIK, PowerBI, DataNet, Tableau) is preferred Has knack for process optimization and automation Adept technically to use tools and techniques to suggest process enhancements Preference to candidates having exposure to AI-powered automation tools to automate complex tasks, analyze data, make decisions, further enhance process efficiency Prefer immediate joiners (on-board before mid-Jun) Duties & Responsibilities: Manage concurrent client projects efficiently, ensuring timely completion of critical setup, case management, and quality assurance tasks within client implementation or benefit change workflows. Conduct comprehensive audits and testing of all phases and features of the client solution to identify and resolve issues. Conduct audits for client and pharmacy benefit setup in accordance with client pharmacy benefit audit procedures. Enter pharmacy benefit details into designated systems following the Client audit process and procedures. Specialize in essential steps supporting various project types including new client pharmacy benefit implementations, medical vendor changes, eligibility modifications, Third Party Administrators (TPA) transitions, Pharmacy Benefit Managers (PBM) shifts, and benefit change requests. Perform Quality Assurance (QA) testing according to standard procedures and report findings for client implementations and existing client pharmacy benefit changes. Conduct initial review of incumbent plan documents and data input for new client implementations, adhering to prescribed systems. Recognize, interpret, and evaluate inconsistencies, discrepancies and inaccuracies in the pharmacy benefit set up data received and alert the proper party for resolution. Document precise test results, including issue locations, screenshots, and member examples when necessary. Know and adhere to HIPPA regulations Acquire proficiency in Pharmacy Benefit Manager (PBM) documentation, software, and reporting systems for contracted Pharmacy Benefit Managers. Apply knowledge of RxBenefits and PBM products/features to support incoming work requests Manage and document day-to-day work activities within a project management software tool Navigate various tools and technologies efficiently. Deliver work in a production-based environment, meeting standards for timeliness and accuracy. Support key projects within our continuous improvement portfolio focusing on more efficient and higher quality deliverables Achieve KPI (Key Performance Indicator) goals set by Operations leadership and department. Show more Show less