Pharmacy Operations Coordinator

Pharmacy Benefit Management (PBM) teams with pharmacies, pharmaceutical manufacturers and physicians to manage the rising costs of prescription drug benefits and costs for our customers.

The Pharmacy Operations Coordinator is responsible for assisting Pharmacy managers, Directors, other Blue Cross and Blue Shield of Alabama departments, Pharmacy providers/vendors, and the Pharmacy Benefit Manager (PBM) in the development, documentation, measurement, implementation, maintenance and communication of pharmacy initiatives and regulatory requirements supporting the Blue Cross corporate strategy and objectives. The position is responsible for developing strategies and related initiatives to support operational and strategic goals.

The incumbent is responsible for all aspects of relationship management with pharmacy-related vendors, partnerships, and business ventures. The position is responsible for negotiating, maintaining and monitoring applicable pharmacy contracts. This may include negotiating fees and services, developing and tracking performance metrics and results, and evaluating compliance with financial terms and contractual and regulatory requirements associated with the contracts. The incumbent is responsible for developing and executing an oversight program sufficient to identify risks, errors, and non-compliance with contracts and/or related operational activities. For deficiencies identified, the incumbent is responsible for establishing and/or evaluating corrective actions to ensure effectiveness of corrections. The position is responsible for communications related to changes and deficiencies of contracts. In addition, this position may facilitate audits and reviews conducted by audit firms, groups and regulatory agencies as applicable.

The position facilitates workgroups where associates from multiple departments must work together to accomplish a goal and will serves as a key stakeholder in divisional and corporate initiatives. The incumbent will work with other divisional areas and vendors to identify and resolve any operational, compliance, and/or administrative issues. In addition, the incumbent will coordinate work of internal team members to complete unit's tasks/goals within established guidelines and timeframes. The position is responsible for acting as a liaison with the pharmacy and provider community to ensure adequate communication, education, and understanding of pharmacy initiatives.

The position is accountable for developing, overseeing, and managing timelines, tracking deliverables, project status, evaluating regulatory guidance, implementing initiatives and regulatory requirements, measuring intended results, maintaining, and communicating internally and externally related to Pharmacy initiatives that support the Pharmacy Business Plan, Pharmacy Balanced Scorecard, or other divisional or corporate goals and strategies. The incumbent will frequently measure, review and report project performance and operational compliance results to Pharmacy management. Additional responsibilities include providing research, analysis, facilitation, and/or administration of Pharmacy Benefit Management (PBM) industry best practices in support of the pharmacy strategy development process.

• Bachelor's Degree
• Four years of experience in a Business Analyst type of role, or proven experience in a related field of business
• Demonstrated problem-solving and analytical skills to research and interpret complex and detailed issues, problems, and opportunities under time constraints
• Experience developing recommendations for solutions or new business opportunities
• Experience leading and directing others in projects to streamline processes, reduce administrative costs, and improve operational activities
• Demonstrated written and verbal communication skills
• Experience developing and presenting information in formal and informal settings
• Demonstrated project management experience, including the coordination of multiple detailed projects
• Demonstrated documentation skills to ensure managers, team members and stakeholders are kept informed about developments, plans, issues, risks, and progress
• Experience overseeing, directing, and organizing project teams to successfully implement initiatives
• Demonstrated independence and completion of assignments without close supervision
• Demonstrated interpersonal skills to facilitate the building and maintenance of relationships with pharmacy partners and vendors and develop a deep understanding of their products and long-term business opportunities
• Experience using negotiation and conflict-management techniques
• Demonstrated organizational and time management skills to direct and execute pharmacy-related contracts
• Knowledge of the Centers for Medicare & Medicaid Services (CMS)/Medicare/government/quality requirements and regulations as applicable to pharmacy products and services as applicable
• Experience interpreting regulatory guidance as well as identifying and implementing required changes as applicable
• Working knowledge of Microsoft Excel, Word, and PowerPoint
• Project Management or Compliance/Audit Certification is preferred
• Pharmaceutical industry knowledge, Pharmacy Benefit Management (PBM) knowledge, overall knowledge of the healthcare industry, or compliance/audit knowledge is preferred
• In-depth knowledge of Blue Cross and Blue Shield of Alabama's products and the changing market needs in order to ensure product development, analysis, and implementation are in line with market demand is preferred
• Working knowledge of claims system processing, appeals, prior authorizations, pharmacy pricing, provider reimbursement, and/or audit processes is preferred
• Experience using Visio, reporting applications, etc. is preferred
  

The work schedule for this position will be hybrid (onsite/remote). Business areas reserve the right to require associates to return to the office as needed, based on performance or other business considerations. A hybrid work schedule is subject to amendment or termination at any time by the Company.

By submitting a job application, I attest that all information to the best of my knowledge is true and accurate. Furthermore, I understand that any information provided by me throughout the job application process is subject to verification including, but not limited to work experience, education, assessment (test) and interviews.
We appreciate your interest in Blue Cross and Blue Shield of Alabama 'The Company'. The Company does not discriminate in hiring or employment on the basis of race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetics, status as a disabled or protected veteran, or because of citizenship status in the case of a citizen or intending citizen. No question on this application is intended to secure information to be used for such discrimination.
Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association