REPORTS TO: Pharmacy Service Team Supervisor

LOCATION: Allegiance Office or Off-site

FLSA STATUS: Non-Exempt

POSITION RESPONSIBILITIES:

The PBM Implementation Coordinator is responsible for the coordination of the implementation for group's benefits with a current or new Pharmacy Benefit Manager (PBM). This includes all support functions necessary to provide accurate information with courteous and timely service to all clients and plan participants. Occasional travel maybe required.

ESSENTIAL JOB FUNCTIONS:

Essential job functions include the following. Other functions may be assigned as business conditions change.

1. Coordinates and schedules meetings with vendors/brokers/ clients as needed for PBM implementations.
2. Assists with reviews and gets approval on ID card approvals from the PBM.
3. Assist with submitting EDI tickets timely and accurately.
4. Attends new group meetings to obtain all information available regarding current pharmacy
5. Maintains meeting notes via OneNote for all new groups and PBM implementations.
6. Assist with updating/maintaining internal PBM implementation checklist/spreadsheet.
7. Assist with getting documentations for compliance/SPD. Obtains clarity on any SPD questions for the compliance department.
8. Assist with getting requests SFTP sites as needed and ensures automation is set up with IT for incoming eligibility reports and claims files.
9. Assist with suppling internal teams with the information needed for the HCI portal.
10. Maintain/updates the PBM contact Spreadsheet for the department.
11. Contributes to the daily workflow with regular and punctual
12. Answers telephone calls, emails, and faxes from PBMs, plan sponsors, plan participants, providers, and internal departments pertaining to pharmacy benefits, claims inquiries; eligibility and programming; provides prompt, clear and accurate responses to requests for information
13. Meets personally with clients as necessary to assist them with questions pertaining to their pharmacy
14. Assists Marketing Department with PBM questions as needed.

NON-ESSENTIAL JOB FUNCTIONS:

1. Performs related or other assigned duties as required or directed.

SUPERVISION EXERCISED:

None.

PHYSICAL WORKING CONDITIONS:

Physical requirements are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Sitting

80%

Reaching

Some

Standing

10%

Manual Dexterity

High

Walking

10%

Telephone

Yes

Kneeling

Some

Computer Screen

High (visual acuity corrected to 20/30)

Bending

Some

Lifting

up to 30 pounds

JOB SPECIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Education: High school graduation or GED required. College degree and/or training in medical terminology preferred.

Certification(s) Required: None

Minimum Experience: Previous experience with computer software applications is required. Work experience with group health benefits or in the health insurance industry preferred.

Other Qualifications:

• Excellent oral and written communication skills required.
• PC skills, including Windows, Excel, Access, Word, internet navigation, and email applications. PowerPoint preferred. Ability to learn all functions of the claims processing software as is necessary for dat