Network Health Administrative Services, LLC
Pharmacy Benefits Specialist I
Network Health Administrative Services, LLC, Menasha, Wisconsin, United States, 54952
The Pharmacy Benefits Specialist I provides basic operational, planning, implementation and reporting support for the Pharmaceutical Benefits area of Network Health Plan. In addition to providing administrative support for the pharmaceutical area of Network Health, the incumbent will build report queries and maintain operational and financial reports; research and resolve claim processing and benefit issues; act as a technical resource for internal users regarding pharmacy benefits; and maintain pharmacy formularies in written and web formats.
Location:
Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at our office in Menasha, or a combination of in person and at your home office (reliable internet is required) with our hybrid workplace model.
Hours:
1.0 FTE, 40 hours per week, 7:30am - 5pm Monday through Friday
Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.
Job Responsibilities
Maintain department websites - after Pharmacy & Therapeutics
Manage large mailings including letter preparation, mail merge and distribution
Create and maintain Prescription Benefit Summary of Member Responsibility Tables
Provide a variety of reports for internal and external stakeholders including Prior Authorization, physician utilization, Controlled Substance Reporting, Annual Quality Improvement Program Evaluation, call log and drug reports related to Key Performance Indicator Board, and work with Sales to run standard reports from Pharmacy Benefits Manager (PBM)
Maintain J-Code Tier Levels billing tables for claims
Answer formulary status questions for Commercial and Medicare Sales, and Customer Service
Assist Care Management/Disease Management with benefit questions, Prior Authorization requirements, and grievances
Pull data for reporting pharmacy trends
Manage the PBM Satisfaction Survey process
Research and resolution of benefit issues
Other duties and responsibilities as assigned
Job Requirements
High School Diploma required
One year of experience in a Pharmacy Tech position
or
one year of experience working with pharmacy benefits required
One (1) year of experience working with pharmacy benefits may substitute for certification
Network Health is an Equal Opportunity Employer
Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
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Location:
Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at our office in Menasha, or a combination of in person and at your home office (reliable internet is required) with our hybrid workplace model.
Hours:
1.0 FTE, 40 hours per week, 7:30am - 5pm Monday through Friday
Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.
Job Responsibilities
Maintain department websites - after Pharmacy & Therapeutics
Manage large mailings including letter preparation, mail merge and distribution
Create and maintain Prescription Benefit Summary of Member Responsibility Tables
Provide a variety of reports for internal and external stakeholders including Prior Authorization, physician utilization, Controlled Substance Reporting, Annual Quality Improvement Program Evaluation, call log and drug reports related to Key Performance Indicator Board, and work with Sales to run standard reports from Pharmacy Benefits Manager (PBM)
Maintain J-Code Tier Levels billing tables for claims
Answer formulary status questions for Commercial and Medicare Sales, and Customer Service
Assist Care Management/Disease Management with benefit questions, Prior Authorization requirements, and grievances
Pull data for reporting pharmacy trends
Manage the PBM Satisfaction Survey process
Research and resolution of benefit issues
Other duties and responsibilities as assigned
Job Requirements
High School Diploma required
One year of experience in a Pharmacy Tech position
or
one year of experience working with pharmacy benefits required
One (1) year of experience working with pharmacy benefits may substitute for certification
Network Health is an Equal Opportunity Employer
Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
#J-18808-Ljbffr