Pharm Benefits Coordinator I

$64,130 - $78,390/Yr

Careoregon - Seattle, WA

Full-time - Entry Level

Remote - Seattle, WA

Insurance Carriers and Related Activities

About the position

The Pharmacy Benefit Coordinator I is responsible for managing the implementation and oversight of pharmacy benefit management operations, particularly focusing on Medicare Part D. This role involves ensuring compliance with regulatory and contractual requirements, responding to inquiries from both external customers and internal departments, and managing small to medium projects related to pharmacy formulary and benefit changes. The position is fully remote with a flexible schedule, requiring candidates to reside in specific states.

Responsibilities

• Manage small to medium projects to implement pharmacy formulary and benefit changes.
• Regularly interface with the Pharmacy Benefit Manager (PBM) to implement, validate, and troubleshoot pharmacy benefit claims processing functions.
• Assist in performing delegation oversight functions of the PBM to ensure contractual and regulatory requirements are met.
• Develop pharmacy data reports for utilization review, formulary and benefit member impact, data validation, and audit purposes.
• Facilitate pharmacy data analysis to develop, test, monitor, and confirm successful implementation plans.
• Represent the pharmacy department at key implementation and operational meetings.
• Act as a point of contact for Pharmacy Benefit Specialists regarding benefits, claims, prior authorizations, and appeals.
• Respond to escalated calls from pharmacy department staff to troubleshoot formulary and benefit issues.
• Assist the Pharmacy Operations Manager and Supervisors with monitoring productivity and performance evaluations.
• Mentor and serve as a role model for new or existing Pharmacy Benefit Specialists.
• Collaborate with other departments on process improvement projects.
• Independently manage special projects and duties assigned by department leadership.

Requirements

• Minimum 2 years' relevant pharmacy benefit experience, such as a pharmacy benefit specialist or coordinator.
• Experience with spreadsheet and basic data file manipulation for testing and validating pharmacy benefit setups.

Nice-to-haves

• Experience in pharmacy claims processing, coding, and pharmacy benefit data analysis.
• Experience in Medicaid, Medicare, and Commercial pharmacy benefit administration.

Benefits

• Estimated hiring range $64,130 - $78,390/year
• 5% bonus target
• Full benefits package