Pharmacy Benefits Administrator

Description

The pharmacy benefits administrator ensures the pharmacy benefits are setup and accurately reflecting the defined benefits provided to members with the PBM. The pharmacy benefits administrator will be responsible for benefit setup and maintenance for all business lines, CMS formulary submissions, pharmacy-related member materials including: formulary, EOC, and SB and prepare competitive analysis reports. This position will work with Sales with prospective clients, as well as with implementation with new employer group benefits. In addition the Pharmacy Benefits Administrator will assist with formulary and benefits analysis and oversee the delegated function of the plan finder tool by the PBM. The pharmacy benefits administrator will participate in a variety of workgroups and be responsible for small projects assigned by the Director of Pharmacy.
Ensure accurate benefit set up by mapping and maintaining group benefits for all business lines.
Ensuring benefits are set up correctly by regular testing/reviewing, resolving errors and by submitting BACRs to PBM.
Ensuring member pharmacy materials are accurate and completed by set deadlines
Ensuring formulary updates are maintained
Ensure CMS formulary compliance by requesting/submitting formulary files to CMS.
Ensure accuracy of Medicare Plan Finder data by performing quality checks and oversight of PBM.
Educating the pharmacy department and other departments of benefit changes for the upcoming year.

Requirements

Certified Pharmacy Technician
Three to Five years of prescription claims experience
Microsoft Office expertise (Word, Excel, Access, Powerpoint)
Experience with a health plan or PBM for at least 3 years in benefits
Excellent communication skills
Ability to research, analyze and resolve pharmacy benefit issues

Requires the use of a computer, telephone, and fax machine.
Travel minimal.