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Pharmacy Formulary Coordinator - Tampa, FL

Company: Wellcare
Location: Tampa
Posted on: July 14, 2019

Job Description:

Pharmacy Formulary Coordinator - Tampa, FL Coordinates and controls the workflow occurring in and out of the department. Tracks and reviews coding issues and issue resolution for formulary and Preferred Drug Lists (PDLs). Partners closely and coordinates with other pharmacy and functional departments on a frequent basis to ensure synergies and cross-departmental effectiveness. Current openings reports to: Mgr, Clinical Implementation or Mgr, Formulary Pharmacy Department: RX-State & Benefit Relations Location: George Rd, Tampa, FL 33634 Essential Functions: Reviews and tracks all aspects of pharmacy claims processing and formulary management for completeness and coding accuracy. (i.e. Medispan information and changes sent to PBM for coding). Ensures Medicare formulary and Medicaid PDL information is complete based on the requirements of the specific line of business. Updates systems with formulary and preferred drug list changes in accordance to line of business and appropriate effective date timelines. Maintains the integrity of the data loaded in to the Formulary Navigator tool for member and provider documents and website searches. Performs ongoing claims testing to ensure accuracy of adjudication at Point of Service. Researches, troubleshoots and resolves claims issues with internal and external partners. Audits the formularies and PDL's to ensure the terms of agreement have been loaded accurately. Provides claims research, analysis, and support during audits (i.e. Acumen, TMPA, CMS program audit, rebate audit) Serves as the primary point of contact for the formularies and PDLs to various internal areas; escalating issues to the appropriate partners across the enterprise. Elevates and regularly works with both internal and external partners regarding member calls concerning eligibility. (i.e. PBM, Pharmacy Help Desk, Customer Service). Tracks requests coming into the department and evaluates trends; involving others as necessary. Oversees the weekly and monthly receipt of Third Party Vendor files. Supports Formulary leadership on initiatives, tasks and projects related to all aspects of the plans' pharmacy benefit for all lines of business (e.g. Medicare, PDP, Medicaid) Follows all state and federal regulations and contractual requirements, including record retention requirements. Performs other duties as assigned. Education: High School Diploma. Experience: 3 years as a Pharmacy Technician - Required Licenses/Certifications: Certified Pharmacy Technician preferred. Technical Skills/Requirements: Intermediate or stronger skill level with Microsoft Office including Excel and Power Point. Medicaid or Medicare experience preferredExcel - VLOOKUPExcel - Pivot tablesExcel - FormulasStrong analytical skillsSpreadsheets & Interpreting data - Large lists and comparingCritical thinking skills - Independent thinkingAbility to prioritize and meet set deadlinesAccess preferred About usHeadquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at . EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

Keywords: Wellcare, Tampa , Pharmacy Formulary Coordinator - Tampa, FL, Healthcare , Tampa, Florida

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