Description

TITLE: Pharmacy Benefits Representative I
DEPARTMENT: Health Care Assistance Program
FLSA STATUS: Non-Exempt
REPORTS TO: HCAP Manager

SUMMARY

The Pharmacy Benefit Representative I is responsible for the triage and management of medications for each HCAP client. This position is also responsible for all medication matters and inquiries from any internal and external source. This role is a subject matter expert in the resolution of pharmacy benefit issues and exception processes.

 ESSENTIAL DUTIES AND RESPONSIBILITIES  include the following:

• Assist clients in maximizing the pharmacy benefits for the HCAP program and serve as an advocate with pharmaceutical companies.
• Guide and educate clients on their prescription benefits, utilization of plan, formulary and in-network pharmacies.
• Efficiently and courteously, respond to all telephone and written inquiries from all clients, providers, pharmacies and community on issues related to benefit eligibility and prescription status.
• Document all relevant client interaction in I.H.S.
• Assist with managing the diabetic supplies program for HCAP clients and employees.
• Review and analyze prescription claims, determine applicable issues, and provide timely resolution.
• Resolve eligibility processing issues with internal eligibility department and PBM.
• Serve as liaison to Patient Assistance Programs by helping clients identify and apply to appropriate programs as needed.
• Demonstrate working knowledge of PBM and application for RX claims submission and eligibility submission.
• Ability to use Facts and Comparisons, FDA CEDAR Drug Updates (or similar programs), for drug eligibility and therapeutic class determinations.
• Utilize medication resources such as Medscape/Medispan to enhance knowledge of formulary applications, pharmacy & therapeutic (P&T) committee functions, generic/brand drug equivalency.
• Provide recommendations on pharmacy services to HCAP leadership.
• Recognize and respond appropriately to drug abuse and pharmacy claim abuse.
• Other duties and responsibilities as deemed necessary.

SUPERVISORY RESPONSIBILITIES

This job has no supervisory responsibilities.

MINIMUM QUALIFICATIONS

• Prefer three years Prescription Benefit Management experience in an HMO/TPA, insurance company or PBM (prescription benefit management) environment.
• High school diploma/GED required. 
• Prefer three years of pharmacy tech experience in appropriate setting or an Associate Degree.

SKILLS AND KNOWLEDGE

• Moderate word processing database and spreadsheet skills required.
• Basic Email and Internet skills required.

CERTIFICATES, LICENSES, REGISTRATIONS

• Certified by the Pharmacy Technician Certification Board (PTCB) under the Texas State Board of Pharmacy. (Current registration certificate must be publicly displayed in their primary place of employment at MCHD)
• Current Texas Driver's License.
• Remain insurable by the current insurance vendor of MCHD.

NOTE: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical Demand Category:

Sedentary Work

Audio-Visual & licensing Demands:

• Vision (Avg)
• Color Discrimination
• Peripheral Vision
• Depth Perception
• Hearing (Avg)

Required License / Certification: Valid Driver's License

Specific Actions Required: In an eight hour day, this job may include:

• Standing/Walking: Occasional
• Sitting: 6-8 Hours
• Driving: Occasional

Work Environment: This job may include:

• Noise

Repetitive Motions: This job will include:

• Simple Grasping
• Fine Manipulation
• Pushing & Pulling
• Finger Dexterity
• Foot Movement

MANEUVERABILITY: This job will require: 

Frequent: 

• Reaching

Occasional: 

• Bending
• Squatting
• Twisting
• Reaching

Qualifications

Salary : $19 - $25