Pharmacy Informatics Specialist

Pharmacy Benefits Specialist IThe Pharmacy Benefits Specialist I provides basic operational, planning, implementation and reporting support for the Pharmaceutical Benefits area of Network Health Plan. In addition to providing administrative support for the pharmaceutical area of Network Health, this role will build report queries and maintain operational and financial reports, research and resolve claim processing and benefit issues, act as a technical resource for internal users regarding pharmacy benefits, and maintain pharmacy formularies in written and web formats. Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required) in combination with at our office in in our hybrid workplace model. Hours: 1.0 FTE, 40 hours per week, 8am-5pm Monday through Friday. Job Responsibilities: Manage large mailings including letter preparation, mail merge, and distributionCreate and maintain Prescription Benefit Summary of Member Responsibility TablesProvide 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 working with Sales to run standard reports from Pharmacy Benefits Manager (PBM)Complete files reviews for denialsMaintain J-Code Tier Levels billing tables for claimsAnswer formulary status questions for Commercial and Medicare Sales, and Customer ServiceAssist Care Management/Disease Management with benefit questions, Prior Authorization requirements, and grievancesPull data for reporting pharmacy trendsManage the PBM Satisfaction Survey processResearch and resolution of benefit issuesBenefit testingOther duties and responsibilities as assignedJob Requirements: High School Diploma or equivalency requiredOne year of experience in a Pharmacy Tech position or one year of experience working with pharmacy benefits requiredCertified Pharmacy Technician preferredOne (1) year of experience working with pharmacy benefits may substitute for certificationNetwork Health is an Equal Opportunity Employer Experience: 1 year required