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AI Summary
The role involves managing pharmacy network price schedules and ensuring accurate claim adjudication. It also includes leading projects for contract compliance and assisting internal departments with reimbursement inquiries.
At our company, we move fast, adapt quickly, and turn challenges into opportunities—all while keeping quality at the heart of everything we do. We believe that work should be a positive and respectful place, and that with the right mindset, anything is achievable.
Our Vision:
Fulfill the essential promise of pharmacy care and help people to live to their healthiest, happiest, and fullest potential.
Our Mission:
To be the disruptive force that drives meaningful change within pharmacy services.
Summary
The Pharmacy Network and Pricing Admin supports network and pricing administration activities to ensure accurate pricing for client and pharmacy claim adjudication, while helping maintain pharmacy provider relations in alignment with industry standards.
Essential Duties and Responsibilities
Our Vision:
Fulfill the essential promise of pharmacy care and help people to live to their healthiest, happiest, and fullest potential.
Our Mission:
To be the disruptive force that drives meaningful change within pharmacy services.
Summary
The Pharmacy Network and Pricing Admin supports network and pricing administration activities to ensure accurate pricing for client and pharmacy claim adjudication, while helping maintain pharmacy provider relations in alignment with industry standards.
Essential Duties and Responsibilities
- Create new and maintain existing client and pharmacy network price schedules
- Audit client and pharmacy network price schedules
- Create and maintain pharmacy networks
- Assist tactical projects specifically focused on mitigating risk and proactively protecting the company’s financial interests
- Assist tactical projects focused on customer satisfaction and implementation as well as streamlining department processes
- Lead projects to ensure pharmacy contract compliance is maintained
- Train team surrounding claim and payment inquiries from pharmacies
- Assist internal departments with pricing, reimbursement and claim processing inquiries
- Execute special pricing and network configurations as required for new business implementations Additional tasks as assigned
Education and Experience
- RX Claim experience required
- High School Diploma required
- A minimum of 3 years of full-time professional experience is required, preferably in the PBM industry.
Knowledge, Skills, and Abilities
- Strong knowledge of database use and functionality.
- Ability to communicate with all individuals within the organization in a manner which illustrates sensitivity, tact and professionalism.
- Excellent ability to analyze, interpret and make decisions based on results.
- Excellent ability to determine trends and data modeling.
- Must be self-motivated and learn quickly.
- Must have the ability to clearly identify developing problems using initiative and independent judgment to make recommendations and/or take immediate corrective action.
- Attention to detail with the ability to prioritize and meet deadlines is required.
- Excellent written and verbal communication skills with the ability to multi-task.
- Must be proficient with MS Office including Outlook, Word, and PowerPoint.
- Advanced knowledge of Excel is required.
Work Environment / Physical Demands
This position is in a typical office environment which requires prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment. May have occasional high stress when dealing with customers/clients. Some travel may be required.
EOE M/F/D/V – WellDyne and HealthDyne are equal opportunity employer and prohibits discrimination of any kind. All employment decisions are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, veteran or disability status, or any other protected status under federal, state, or local law.
EOE M/F/D/V – WellDyne and HealthDyne are equal opportunity employer and prohibits discrimination of any kind. All employment decisions are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, veteran or disability status, or any other protected status under federal, state, or local law.
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