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POST DATE 9/16/2016
END DATE 3/21/2017
Franklin Lakes, NJ
JOB DESCRIPTIONAdvance your career with the company that makes it easier for people to choose better health.
Express Scripts is a leading healthcare company serving tens of millions of consumers. We are looking for individuals who are passionate, creative and committed to creating systems and service solutions that promote better health outcomes. Join the company that Fortune magazine ranked as one of the "Most Admired Companies" in the pharmacy category. Then, use your intelligence, creativity, integrity and hard work to help us enhance our products and services. We offer a highly competitive base salary and a comprehensive benefits program, including medical, prescription drug, dental, vision, 401(k) with company match, life insurance, paid time off, tuition assistance and an employee stock purchase plan.
Express Scripts is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation. Express Scripts is a VEVRAA Federal Contractor.
* Accurately capture and document new clinical benefit requirements
* Provide excellent customer service and act as a trusted client advisor
* Work with internal partners to ensure all implications of requested clinical benefit requirements are vetted, understood and communicated as necessary
* Accountable for timely and accurate translation of client intent into F14 system configuration
* Track and communicate status of service requests as necessary
* Assist in remediating process gaps and documenting best practices
* Intent capture, documentation and client advisor
* Meet with clients to discuss and clarify clinical benefit requirements
* Advise clients on the most efficient way to implement intent within F14 systems
* Understand client's existing clinical benefit and business philosophy to help avoid unnecessary clarifications
* Analyze new requirement against existing setup
* Clarifying implications of intent
* Identify interdependent functionalities, programs or areas that may be impacted by the request (i.e. member communications, rebates, finance, networks, etc)
* Consult with team members, SMEs and specialized teams as necessary
* Benefit Intent Champion
* Client Benefit Administrators (CBA)
* Clinical Application Teams (DCRS, FRS, CRS, Criteria)
* Account Teams
* Product Owners
* Provide assistance to team members with issues needing clinical interpretation and guidance
* Translating intent into F14
* Translate requirements as necessary into internal requests/submissions
* Ensure requests are routed to the appropriate functional areas/specialists
* Serve as business owners to necessary IT projects that involve clinical benefits
* Tracking/communicating status
* Manages and tracks all requests to ensure timelines are met including the proactive management of client specific performance guarantees.
* Responsible for communicating completed benefit notifications to client with documentation of accurate set up.
* Ensuring accuracy
* Complete random review of work completed by coding teams
* Periodically monitor claims to ensure the benefit is coded to match client intent
* Process gap remediation/best practice documentation
* Develop a deep understanding of our claims adjudication system and associated clinical applications
* Identify and help remediate any process gaps, develop and document best practices by creating or modifying existing to existing SOPS, process maps, references and intent forms
* Will act as resource in the build and maintenance of the Intent Gathering Tool
* RPh, PharmD preferred
* 10-14 years relevant experience
* Current RPh Licensure in good standing as required by the state in which work is performed
* Microsoft office with a strong understanding of Excel and Access
* Written and verbal communication (listening, feedback; translating complex ideas/processes), collaboration, analytical thinking/critical thinking, results-oriented and organizational skills.
* In depth understanding of F14 adjudication system and associated clinical applications.
* In depth understanding of operations organizational structure along with roles and responsibilities of departments involved with clinical request types (Tribal Knowledge)
Express Scripts is an EOE
Express Scripts is an Equal Employment Opportunity employer and does not discriminate in employment opportunities or practices on the basis of race, creed, color, religion, sex, national origin, nationality, ancestry, age, disability or status as a disabled veteran or veteran of the Vietnam era, pregnancy, affectional or sexual orientation, gender identity or expression, marital status, status with regard to public assistance, veteran status, citizenship or membership in any other legally protected class. None of the questions in this application are intended to elicit information regarding any protected characteristics, nor imply any limitation, illegal preferences or discrimination based upon non-job-related information or protected characteristics. Applicants must be able to pass a drug test and background investigation and, depending on position requirements, a Department of Defense background investigation. AA/EOE.