GENERAL SUMMARY
Responsible for facilitating the implementation and administration of company system modules for all health plans. Analyzes the daily operations of group and membership enrollment process, along with the analysis of pharmacy benefit, provider, and vendor files. Develops, maintains, and produces monthly management reports related to pharmacy benefit movement.
ESSENTIAL RESPONSIBILITIES
- Analyzes, audits, and edits the statistical summary of monthly pharmacy benefit movement.
- Prepares, evaluates, and maintains reports and matrices regarding all pharmacy benefits.
- Evaluates system code files structures to ensure appropriate relationships for the business environment related to pharmacy.
- Assists managers and Clinical Pharmacy Directors in the development of new pharmacy benefits based on criteria submitted from the plans.
- Summarizes and interprets coverage and the conversion of pharmacy benefit structures for existing employer group files as well as for acquired HMOs.
- Manages the addition and termination of pharmacy benefits by plan. Ensures the accuracy of pharmacy benefit data entered into the employer group database.
- Monitors Department of Insurance approval of pharmacy benefits.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor’s degree or equivalent experience.
- Significant experience (usually 3+ years) with HMO operations.
- Substantive knowledge of managed care policy and direction.
- Knowledge of ICD-9 and CPT codes desired.
- Strong analytic and problem solving abilities.
- Must have strong communication skills and be detail oriented.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: Franklin, TN, US
Organization: 10300 - Coventry Services Corp
Schedule: Full-time
Job Posting: 2013-02-01 00:00:00.0
Job ID: 1310403