ESSENTIAL ROLES AND RESPONSIBILITIES Understands business processes, issues and user requirements. Assists in the collection and consolidation of required information and data. Prepares requirements, specifications, business processes and recommendations. Masters data banks used by PharmPix like Medispan and NCPDP, etc. Ensure that all rejected and paid claims are adjudicated and/or rejected as specified by the client and /or PharmPix policies and procedures (Internal Audits). Clients’ implementations including but not limited to: meetings, communications, and tests. Accurately add benefit rules set, contracted networks, co payment rules set, Dur rules set and all necessary information into CUBE in order to assure an implementation set up error Perform testing to ensure benefits, dur rules, co payment rules and formulary are implemented correctly as stipulated by client. Perform testing to ensure reimbursements to pharmacies are adjudicating in accordance with the network contract. Assists in enforcement of projects deadlines and schedules. Assists in coordinating resolution of situations with pharmacies, members or clients as outlined in policies and procedures. Ensures issues are identified, tracked, reported on and resolved in a timely manner. Proactively seeks opportunities to broaden and deepen knowledge base and proficiencies. Actively applies feedback received to day-to-day work and strives to improve performance. Complies with all company policies and procedures. Continuous interaction with colleagues. Support all Quality Management Program initiatives. Special projects and/or other duties assigned by the Benefit Manager TRAINING & EDUCATION Associate Degree in Pharmacy Technician (CPhT preferred) PROFESSIONAL EXPERIENCE 1 year's experience in a PBM/Health Plan Environment (Preferred); or Proven working experience as a data analyst; or 2 years’ experience in IT environments. PROFESSIONAL COMPETENCIES Ability to read and interpret documents, write reports and correspondence. Speak effectively before groups of PharmPix clients. Demonstrated effective organizational and communications skills. Strong verbal and written communications skills Fully bilingual English and Spanish Able to effectively interact with internal departments, PharmPix clients and other healthcare professionals. Time Management Skills: Establishing priorities and accomplishing tasks in a timely manner PC PC skills (Microsoft System)/System oriented. Ability to work independently and with minimal supervision, demonstrating initiative and problem-solving skills.
