Responsible for support functions to ensure correct coding is in place for medications and plan rules, web tools are accurate to the benefits at a member level by working in both BCBSAZ internal system and external vendor applications.
LEVEL 1 – PERFORMS JOB FUNCTIONS UNDER CLOSE SUPERVISION BY ANALYST OR PEER REVIEW
• Coding of PBM adjudication system for quality and accuracy to meet or exceed turn-around times
• Coding of vendor application(s) related to web support (RxPortal and MMIT) to ensure unique custom tier lists are accurate and working correctly within the BCBSAZ member portal.
• Support internal customers with information on benefits applicable to medication claims
• Perform, evaluate, and assist in defining and improving the quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
• Administer, interpret, and maintain current working knowledge of required BCBSAZ systems, procedures, forms and manuals
• Supports Analysts in researching and communicating recommendations in regard to medication claim processing and benefit system coding.
• Supports Analysts tasks to monitor and investigate reported system issues
• Participates in quality initiatives; including functions that support audits, reporting, evaluation of quality opportunities and concerns, and creation and implementation of corrective actions as requested.
Preferred Skills for Pharmacy System Support Specialist:
- MS Office Suite - word, excel, etc.
- Knowledge of Medispan or First Data Bank drug coding and how that relates to adjudication platform coding
- Data entry into the claims adjudication platform (RxClaim)
- History of providing or interpreting data/reports
- Review new drug/drug formulary changes and interpret how they impact different lines of business. Effectively update system(s) based on each line of business.
Required Work Experience
- 1 Year Experience in pharmacy or medical field
- 1 Year Experience in prescription benefit administration
- 1 Year Experience working in vendor applications (adjudication, web tools, formulary tools)
- High-School Diploma or GED
Preferred Work Experience
- 1 year Working with language and web tools
- 3 years Experience with a pharmacy benefit management or prescription claim administration
- 1 year Experience with the current BCBSAZ PBM system
- 2 years Demonstrated experience handling confidential information
- 2 Years Demonstrated experience handling vendor system coding and analytic functions
- Associate’s degree in general field of study
Required Job Skills
- Intermediate PC proficiency with word processing, spreadsheets, and claims and imaging software (Level 1)
- Intermediate skill using office equipment, including copiers, fax machines, scanners and telephones (all Levels)
- Advanced knowledge of HTLM and web tools
Required Professional Competencies
- Take initiative
- Establish and maintain working relationships in a collaborative team environment
- Flexibility in prioritization of workflow
- Compose a variety of business correspondence
Required Leadership Experience and Competencies
- Make use of employees' skills and abilities to deliver business objectives
- Use available information to focus the team's activities and identify priorities
You will be redirected to our career site to apply to job number 4119. Thank you!
BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.