6 Medicare Pharmacy Benefit Coordinator Jobs in Honolulu, HI
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Medicare Pharmacy Benefit Coordinator
$119k-140k (estimate)
Full Time | Ambulatory Healthcare Services
4 Days Ago
HMSA is Hiring a Medicare Pharmacy Benefit Coordinator Near Honolulu, HI
Job Summary
Note: Individuals typically begin between the minimum to middle of the pay range
Optimize Medicare member experience by identifying and performing process improvement initiatives.
Minimum Qualifications
- Hybrid Work Environment - Must reside in Hawaii**
Note: Individuals typically begin between the minimum to middle of the pay range
Optimize Medicare member experience by identifying and performing process improvement initiatives.
Minimum Qualifications
- Bachelor's degree and three years of related work experience; or an equivalent combination of education and related work experience.
- Strong oral and written communication skills.
- Proficiency in development and execution of operational workflows.
- Basic knowledge of Microsoft Office applications. Including but not limited to Word, Excel, Outlook, and Power Point.
- Support the pharmacy strategy from a Medicare benefit design and delivery perspective.
- Maintain a deep understanding of Medicare benefits.
- Work with internal HMSA staff to drive benefit design and delivery that will foster ideal member care.
- Analyze business needs and data, develop feasible solutions, implement changes, and evaluate effectiveness of changes.
- Work with external stakeholders such as the Pharmacy Benefit Manager (PBM) to operationalize benefits.
- Collaborate with the PBM to provide the best benefit product/service.
- Perform oversight of the PBM and other entities as applicable to ensure the benefit is provided as intended.
- Implement, test, and evaluate changes made within the PBM
- Lead and support project management and communications.
- Manage projects that coordinate and implement clinical initiatives and/or pharmacy benefit operations and improvements.
- Conduct research, evaluation of measures and value assessments of initiatives and/or programs.
- Assess compliance with Federal and State regulations, internal policies, procedures, and workflows.
- Streamline workflows.
- Review and edit requirements, specifications, business processes and recommendations related to proposed solutions.
- Coordinate and facilitate planning, tracking, and installation of business requirements and deliverables.
- Perform outreach as necessary to support pharmacy and quality strategies.
- Provide quality, objective, and professional analyses of business needs and PBM capabilities/limitations.
- Develop communications as appropriate to facilitate ideal utilization of pharmacy benefits.
- Develop policy and procedures, work instructions, training materials, and employee training.
- Manage incoming Pharmacy Management inquiries with a superior level of customer service.
- Coordinate problem solving associated with inquiries and follow through to resolution.
- Identify root causes of individual and/or trending encounters and carry out process improvement initiatives.
- Triage inquiries, if necessary, to ensure servicing needs are properly identified and addressed.
- Lead Medicare Point-of-Sale Operational Tasks.
- Reconcile all benefit and coding related documents to ensure accuracy and timely updates as necessary
- Define acceptance testing criteria and ensure that the criteria are met before system changes are implemented
- Maintain PBM system functionality to ensure operational efficienc
- Monitor and evaluate accuracy of pharmacy drug benefit through testing review and validations; report monitoring and/or live claim review.
- Ensure HMSA meets performance standards stated by government regulations, employer groups, Blue Cross Blue Shield Association, internal policies, procedures, workflows and business requirements.
- Manage special projects as assigned.
- Performs all other miscellaneous responsibilities and duties as assigned or directed.
Job Summary
JOB TYPE
Full Time
INDUSTRY
Ambulatory Healthcare Services
SALARY
$119k-140k (estimate)
POST DATE
06/29/2024
EXPIRATION DATE
07/27/2024
WEBSITE
hmsa.com
HEADQUARTERS
LIHUE, HI
SIZE
1,000 - 3,000
FOUNDED
1938
TYPE
NGO/NPO/NFP/Organization/Association
CEO
BENNETT JACOBY
REVENUE
$1B - $3B
INDUSTRY
Ambulatory Healthcare Services
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About HMSA
Hawaii Medical Service is a health insurer service provider.
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