Pharmacy Benefit Program Specialist (Closes 1/10/2025)

Summary

Overall responsibilities require a full understanding of policies and procedures, guidelines and regulations governing the Allegheny County Department of Human Services Mental Health Prescription Program.  Duties include ensuring eligibility status of consumers prior to entering the Determination of Maximum Liability Form 878 into the the Optum software application. Development of expertise necessary to fully operate the software application is necessary.  Duties also include costs and program utilization review.  Person(s) in this position will gather information from Optum system and other sources and will prepare reports requested by the supervisor and program management.  Position entails monitoring of provider programs, pharmacies and the company contracted to process claims for the program: Optum Pharmacy Benefits Management Company.  Preparing written correspondence to providers, pharmacies and others is required.  Maintains accurate and timely records on pending and closed projects and reports.  Will proactively seek and provide timely answers to questions coming from Service Coordination Unit (SCU) staff, pharmacists, consumers and others using or inquiring about the program.  Responsible for evaluating the Mental Health Prescription Benefit Program’s practices and design.  Recommends practices for improvement while ensuring all applicable government regulatory standards and Allegheny County polices are met.

Essential Duties and Responsibilities

Eligibility Maintenance

• Ensures eligibility status of consumers prior to entering the Determination of Maximum Liability Form 878 into Optum’s on-line system. This process includes periodically checking the fax machine for requests from the Outpatient Mental Health Centers.  This encompasses the following:
  • Registering clients.
  • Reviewing the forms to ensure information is complete and accurate.
  • Contacting the appropriate Outpatient Mental Health Center representative when the information is unclear or a question as to the consumer’s eligibility status arises.
  • Facilitating the approval from the supervisor when a special condition to a consumer’s eligibility status applies.
• Responds to questions from consumers, agency representatives, pharmacy representatives, Optum representatives and supervisor.

Policies and Procedures

• Reviews drafts of Allegheny County MH DHS/OBH Prescription Program policies and procedures when new guidelines and/or changes to existing guideline are proposed. Recommends revision and appropriate precise recommendations with supervisor. 
• Assists in performing semi-annual reviews of Allegheny County MH DHS/OBH Prescription Policy and Procedure Statements. Makes recommendations for updates as appropriate.

Coordination of Optum Services

• Assists in gathering information to facilitate the drafting of agreements and request for proposals.
• Assists in reviewing the technical section of the proposal.
• Assists in performing quality assurance audits.

Internet Queries

• Performs pharmacy-related Internet queries, as required for program operations by the Supervisor.

Prescription Eligibility Training

• Responsible for training all new employees to prescription eligibility system.
• Maintains educational material used in training process and updates the materials to reflect current applications, including the maintenance of written plans and procedures to be reviewed by the supervisor, which describes the systematic process whereby consumers are registered for MH prescription coverage.

Supervisory Responsibilities

This job has no supervisory responsibilities.

Additional Responsibilities

From time to time the employee will be required to perform additional tasks and duties as required by the employer. 

• Acts as a back-up to the supervisor when needed, as well as be willing to take calls on weekends and evenings when supervisor is unavailable.
• Ordering of office supplies and distribution
• Fills requests for additional prescription pads, has the prescriptions numbers activated through Optum and distributes prescription pads to requested SCU Units.

Knowledge, Skills and Abilities

• Comprehensive knowledge and understanding of the policies, procedures and regulations governing the Allegheny County Department of Human Services, Office of Behavioral Health MH Prescription Program.
• Working knowledge of the software utilized to register consumers and query data stored by the Optum Company, as well as OnBase and CIPS (Client Information Payment System).
• Strong interpersonal and communication skills, both oral and written,
• Demonstrated ability to set priorities, exercise good judgment and work with minimal supervision.
• Manage multiple assignments and accomplish a wide variety of tasks with attention to detail.
• Demonstrate a significant level of responsibility.
• Knowledge of database applications and the ability to work well with computers and computer software as required e.g., Office, Excel, Word, PowerPoint and Internet Explorer.
• Knowledge of general office equipment, e.g., computer, calculator, fax machine, copier.

Education/Experience Requirements

Bachelor’s degree, preferably in Business Administration, Accounting, Psychology, plus at least two years Human Services or audit related experience.

-OR-

Any equivalent combination of education and experience which provides the required knowledge, skills and abilities.

Certificates, Licenses, Registrations

Act 33 & 34 clearances.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above 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, consistent with applicable law.

Salary : $52,000 - $57,000