Pharmacy Benefits Administrator

Overview:

RxSense is a Boston-based health technology company offering powerful technology solutions built to make prescription drugs more affordable for all.  We operate two business units – Enterprise Platform Solutions, which provides turnkey technology services to employers, health plans and others who wish to administer pharmacy benefits, and Direct to Consumer (DTC), which offers cash pay prescription benefits to people under the consumer brand SingleCare. 

Incorporated in 2014, RxSense is one of the fastest growing companies in New England. We are privately held and proud to have been recognized by Fast Company as one of 2020’s Most Innovative Companies, and by Forbes as a 2020 Best Startup Employer.  Our CEO and Founder, Rick Bates, was named the EY New England Entrepreneur of the Year award winner in 2018. 

Job summary:

The Pharmacy Benefit Administrator will have an excellent working knowledge of RxSense products and processes and establish day to day support relationships with operational areas. Pharmacy Benefits Admin will be responsible for managing tasks and projects related to implementations, benefits, pricing, hierarchy, sets ups, testing and maintenance. The Pharmacy Benefits Administrator will be actively engaged and involved in client interaction including leading client implementation discovery and working sessions. The Pharmacy Benefits Administrator will be subject matter expert for items noted above in addition to knowing and understanding how these interact or impact other areas such as pricing, clinical, etc. The individual will act as a junior implementation manager able to assist in multiple areas of an implementation.

Primary Duties & Responsibilities:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

• Develop a high degree of knowledge about pharmacy claims and RxSense claims platforms. 
• Set up and maintain benefits, clinical, networks, pricing and hierarchies
• Establish/maintain relationships with client services, pharmacy networks, implementations, UAT/QA, IT, finance, clinical staff with focus on flawless implementations 
• Assist implementation team during client implementation calls by leading all benefit and hierarchy discovery and configuration sessions.
• Gain a thorough understanding of client benefit designs and implement accurately
• Build solid working relationships both internally and externally with clients
• Test set ups prior to implement to production
• Troubleshoot benefit set up issues and propose solutions including updating processes to avoid future issues
• Coordinate impact analysis for identified issues
• Train other internal department staff and private label clients on set up needs.
• Assist clients on best approach for their set up needs in our consultative role
• Assist management in developing and maintaining department policy and procedures
• Assist the Director and staff with process and development projects

Desired Knowledge, Skills, & Abilities:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

• Experience with pharmacy technology and claims processing. Strong Experience with Microsoft Suite
• Must be able to develop and maintain strong working relationships on a multi-level basis. 
• Superior written and verbal communication skills - ability to communicate information & ideas clearly & concisely both internal and external (client facing)
• Excellent organizational & time management skills.
• Ability to work in a dynamic fast paced atmosphere.
• Proven ability to work independently and drive results
• Detail-oriented, ability to multitask, proactive thinker
• Experience with pharmacy claims processing, benefit design, testing, hierarchy, copayment, accumulators, clinical rules
• Experience with client implementations
• Ability to research, analyze and resolve pharmacy benefit issues independently.
• Ability to take the lead on projects and see them through to completion.

Education &/ or Skills:

• Bachelor’s degree or equivalent experience in healthcare (PBM), client implementations, plan builds,  customer service, and claims processing"

Physical Work Environment:

​​​Remote position with limited travel (typically quarterly to a corporate location)​​​​​