PURPOSE OF THE ROLE
The Plan Benefit Coding Specialist will be responsible for reviewing, analyzing, modifying and testing the adjudication system as it pertains to benefit plan design. This position will work closely with various departments of the Script Care Ltd. organization; including but not limited to, Platform Management, Quality Assurance and Operations. The role requires a strong technical aptitude, as well as robust analytical and investigational problem- solving skills. The PBCS will report directly to the Director of Platform Management.
KEY TASKS & RESPONSIBILITIES
- Work collaboratively with the Director of Platform Management, Chief Management Officer and other executives to set objectives.
- Create, test and maintain group and plan information such as additions, modifications and terms in the adjudication system. Review and report any discrepancies.
- Update pricing, drug lists, benefit lists, pharmacy networks and other items that affect plan benefits. Review and report any discrepancies.
- Assist all departments with questions and troubleshoot issues as they relate to plan setup, rejections, overrides, etc.
- Create and run various reports, as requested
- Work with Director of Platform Management on programming requests for new functionality necessary to code benefit designs.
- Able to run and analyze full regression and new test claims to ensure benefit designs are coded accurately. Review and report discrepancies.
- Test and audit new versions of the adjudication platform as they pertain to benefit design capability. Review and report any discrepancies.
- Able to manage and support multiple projects, tasks, initiatives and deliverables simultaneously while paying close attention to deadlines
- Ability to interpret, comprehend and deploy changes under various time constraints
- Must be a self-starter and able to work independently
- Bachelor’s Degree preferred
- Experience in benefit plan coding, preferably in a Pharmacy Benefit Manager environment
PROFESSIONAL SKILLS, EXPERIENCE & COMPETENCIES
- Proficient with the full Microsoft Office suite with a willing and eagerness to learn new software programs as needed
- Excellent written and verbal communication skills, with the ability to successfully communicate with individuals from various levels of the organization
- Willing to travel as needed
- Able to provide insight and individual analyses on issues pertaining to benefit plan design and platform management
- Must be organized, possess a strong attention to detail and have exceptional follow-through skills
- Demonstrated ability to think independently and execute on decisions Willingness to occasionally work outside of norm