Pharmacy Benefits Specialist I

Location: Candidates must reside in the state of Wisconsin. This is a hybrid role; eligible to work from a home office (reliable internet required) in combination with the office in Menasha.

About the role

The Pharmacy Benefits Specialist I provides operational, planning, implementation, and reporting support for the Pharmaceutical Benefits area of Network Health Plan. Responsibilities include administrative support, building report queries, maintaining operational and financial reports, researching and resolving claim processing and benefit issues, acting as a technical resource for internal users regarding pharmacy benefits, and maintaining pharmacy formularies in written and web formats.

Responsibilities

• Manage large mailings including letter preparation, mail merge, and distribution
• Create and maintain Prescription Benefit Summary of Member Responsibility Tables
• Provide a variety of reports for internal and external stakeholders, including Prior Authorization, physician utilization, Controlled Substance Reporting, Annual Quality Improvement Program Evaluation, call log and drug reports related to Key Performance Indicator Board, and standard reports from Pharmacy Benefits Manager (PBM) for Sales
• Complete files reviews for denials
• Maintain J-Code Tier Levels billing tables for claims
• Answer formulary status questions for Commercial and Medicare Sales, and Customer Service
• Assist Care Management/Disease Management with benefit questions, Prior Authorization requirements, and grievances
• Pull data for reporting pharmacy trends
• Manage the PBM Satisfaction Survey process
• Research and resolution of benefit issues
• Benefit testing
• Other duties and responsibilities as assigned

Requirements

• High School Diploma or equivalency required
• One year of experience in a Pharmacy Tech position or one year of experience working with pharmacy benefits required
• Certified Pharmacy Technician preferred (one year of experience working with pharmacy benefits may substitute for certification)

Schedule

1.0 FTE, 40 hours per week, 8:00 AM – 5:00 PM, Monday through Friday

Benefits

Employees have the opportunity to participate in paid volunteer activities in their local communities.