Formulary Operations Specialist

Position Responsibilities

• Supports the weekly, monthly, and quarterly maintenance and quality assurance checks of standard and custom formularies for all lines of business including Commercial, Medicaid, Medicare Part D, and the Health Information Marketplace
• Affords assistance to the pharmacists in operationalizing and implementing custom client formulary and benefit requests within the formulary management and adjudication platform
• Triage and provides assistance with Salesforce cases for custom formularies
• Triage and monitors the Formulary Operations inbox
• Uploads formulary composites in the adjudication platform and supports the Benefits team in testing by uploading adjudication data to applicable Salesforce cases
• Affords assistance to the pharmacists with cross-functional support for claim troubleshooting through the adjudication platform
• Reviews formulary testing output templates for formulary accuracy
• Supports the creation, maintenance, and validation of client and formulary marketing materials in the formulary management tool
• Conducts adjudication system maintenance data entry activities
• Inputs inactive to active NDC updates
• Supplemental list updates in Medispan for pharmacists to perform quality checks
• Creates non-formulary tier flips in the formulary management tool
• Performs weekly formulary updates for Liberty, Freedom, and standard HIM formularies
• Performs Monthly Specialty formulary updates in the formulary management tool
• Provides support to Weekly New Drug to Market updates
• Affords assistance in creating job aids for Formulary Operations
• Develops and maintains departmental SharePoint sites
• Completes assigned work plan objectives and projects on a timely basis
• Ensures quality assurance and formulary accuracy
• Supports quality improvement projects, as required
• Supports RFI and RFP submissions, as required
• Supports general business needs and operations, as required
• Responsible for adherence to the Judi Rx Code of Conduct, including reporting of noncompliance

Required Qualifications

• Registered Pharmacy Technician license
• Certification from the National Pharmacy Technician Certification Board or National Health career Association or equivalent experience
• 3-4 years of pharmacy experience working for a health plan or PBM
• Formulary development and maintenance process experience at a PBM or health plan including experience with custom client benefit and formulary design (highly preferred)
• Proficient in Microsoft office suite with emphasis on Microsoft Excel including advanced Microsoft Excel functions, VBA, macros, etc.
• Experience working with large datasets required
• Knowledge of pharmacy claims processing, drug names, and pharmacy/medical terminology
• High attention to detail required
• Ability to work independently and accurately in a fast-paced environment
• Flexible, highly organized, and able to shift priorities easily
• Ability to balance multiple projects simultaneously
• Commitment to delivering a high-quality work product