Pharmacy Information Services Specialist II

Job Description - Pharmacy Information Services Specialist II (2400463)

Job Description

Pharmacy Information Services Specialist II-(2400463)

Description

Note, this is a remote opportunity in Ohio. Ohio candidates preferred

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.

2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Collaborates with internal and external partners to plan, test, and implement pharmacy projects for commercial and government lines of business.

Coordinates ongoing regulatory reporting with pharmacy analysts and pharmacy provisioning activities with vendors and end users.

Designs and validates maximum out of pocket accumulator, data base management, and data file transfer processes to and from vendors.

Creates, files, and validates drug lists, pricing and formulary files, assists with annual pharmacy specific mailings, and participates in the reconciliation of drug claim rebates and discount guarantees.

Supports, maintains, and documents pharmacy initiatives and processes.

Responsibilities

Partners with cross-functional teams to support implementation efforts for commercial and government programs pharmacy products.

Participates in development, implementation, and testing of new pharmacy initiatives and enhancements to existing processes, and ongoing oversight.

• Assures compliance with contractual requirements of Pharmacy Benefit Manager (PBM) vendor for processing of pharmacy claims, accumulator transfers, performance guarantees, provisioning, and adjustments.
• Assists IT and data users with understanding of vendor file layouts, development of data files and establishing new data file transmissions with vendors.

Supports changes to existing file transfers when necessary.

• Develops and maintains departmental policies and procedures (P & Ps).Documents new processes, creating and cataloging new P&Ps, and reviewing existing P&P annually to ensure they are up to date.
• Supports Pharmacy, Finance and Sales with pharmacy rebate and discount reconciliation processes.Supports internal teams with processes specific to group billing of pharmacy claims processes, preparation of annual regulatory reporting, and validation of data posted to member facing websites.
• Performs other duties as assigned, including assisting with annual creditable coverage mailing.

Qualifications

Qualifications

• Bachelor’s degree in business or healthcare administration or related field. In lieu of degree, may consider equivalent combination or education / training and experience.
• 2 years of experience with pharmacy data services and / or systems in a health plan or PBM, or equivalent experience in healthcare or financial services.
• Strong health insurance claims processing and membership systems, database management, and Microsoft Office (especially Excel, Access, and Power BI) skills.
• Knowledge of interfacing health plan data, including membership and claims, with a prescription drug management (PBM) company.
• Knowledge of PBM benefits set up, claims processing, and related regulatory requirements.
• Knowledge of and the ability to work with prescription drug price and descriptive data, rebate data, pharmacy network data, and formulary data and use of these data types to create reports, databases, and data files.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees.

That's why we offer an exceptional package that includes :

A Great Place to Work :

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available.

Enjoy the use of weights, cardio machines, locker rooms, classes and more.

• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation :

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work / life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You :

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual :

Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors.

Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There’s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans.

We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans.

Our plans provide peace of mind to more than 1.2 million Ohioans.

We’re not just one of the largest health insurance companies based in Ohio, we’re also the longest running. Founded in 1934, we’re proud of our rich history with the communities where we live and work.

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community.

We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

Primary Location

US-Ohio

7 - General Staff

Organization

Pharmacy

Schedule

Regular

Shift

Standard

Employee Status

Individual Contributor

Job Type

Full-time

Job Level

Day Job

Job Posting

Oct 18, 2024, 8 : 06 : 10 PM