Imagine360 is seeking a Prescription Drug Benefit Coordinator. The Prescription Drug Benefit Coordinator works closely with department members, providers and third parties to proactively assist in researching concerns and resolving issues to the satisfaction of the client and in accordance with plan provisions. This individual also provides reporting to clients and implements new and revised prescription benefit plans through direct interaction with clients and Prescription Benefit Manager (PBM) Vendor. This individual maintains a comprehensive understanding of the plan document(s) under their scope of responsibility.
Position Location: 100% remote
Responsibilities include but are not limited to:
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Prescription Benefits
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Communicates effectively and efficiently with all clients, pharmacies or customers (internally and externally) telephonically and electronically, responding to requests in a timely manner.
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Acts as point of contact with the Prescription Benefit Manager (PBM) vendors.
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Accurately implements new Plan set-up and Plan Benefit changes to PBM vendor
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Reviews and maintains plan parameters for prescription plans.
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Audits plan set up/changes for accuracy.
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Coordinates eligibility with the PBM.
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Performs manual additions and deletions of eligibility information daily in Prescription software.
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Documentation of Business Processes
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Reporting
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Report Management.
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Requests special reports from Prescription Benefit Manager regarding plan's monthly usage, reviews for accuracy and posts to appropriate client sites.
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Run required reports for EBMS and its clients; customizes per client requests.
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Runs prescription invoice detail reports and provides to designated internal/external customers
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Prescription Ad hoc reporting as requested to support external/internal customers
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Prescription Appeals
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Provides support to the appeals team in the documentation needed for the review of the appeal.
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Prescription Identification
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Codes prescription claims for manually and electronically summited claims
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Performs NDC look-up for prescriptions submitted without coding description.
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Mailings
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Coordinates the creation, printing, and distribution of Prescription information pieces.
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Customer Service
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Acts as a role model in demonstrating the core values in customer service delivery.
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Appropriately escalates difficult issues up the chain of command.
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Trains new employees/and cross departmentally as assigned.
- Explains and demonstrates duties and proper procedures in performing duties.
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Quality Assurance
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Reviews and maintains plan parameters for prescription plans.
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Serves on committees, work groups, and/or process improvement teams, as assigned, to assist in improving quality/customer satisfaction.
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Recognizes and alerts appropriate supervisor of trends within their scope of responsibility that fall outside of quality parameters.
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Performs self-quality monitoring in order to develop and execute plans to meet established goals.
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Provides ongoing feedback to help optimize quality performance.
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Collaborates with others and cross-departmentally to improve or streamline procedures.
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Develops new or improves current internal processes to improve quality
Required Education/Experience:
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High School Diploma or equivalent
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2+ years of Legal/Benefit Plan Compliance experience or related work experience.
Preferred Education/Experience
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Associate's Degree or equivalent experience
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2 years of pharmacy or medical setting experience. Medical coding experience.
What can Imagine360 offer you?
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Multiple Health Plan Options, including a 100% employee paid premiums
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100% Company paid employee premiums for Dental, Vision, STA, & LTD, plus Life Insurance
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Parental Leave Policy
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20 days PTO to start / 10 Paid Holidays
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Tuition reimbursement
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401k Company contribution
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Professional development initiatives / continuous learning opportunities
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Opportunities to participate in and support the company's diversity and inclusion initiatives
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Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.
Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.
**RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation**