Formulary Operations Specialist

Formulary Operations Specialist

Charlotte, North Carolina, United States; Denver, Colorado, United States; New York, New York, United States

About Judi Health

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels. At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care.

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Position Responsibilities:

• Supports the weekly, monthly, and quarterly maintenance and quality assurance checks of standard and custom formularies for all lines of business including Commercial, Medicaid, Medicare Part D, and the Health Information Marketplace
• Assists the pharmacists in operationalizing and implementing custom client formulary and benefit requests within the formulary management and adjudication platform
• Triages and assists with Salesforce cases for custom formularies
• Triages and monitors the Formulary Operations inbox
• Uploads formulary composites in the adjudication platform and supports Benefits team testing by uploading adjudication data to applicable Salesforce cases
• Assists the pharmacists with cross functional support for claim troubleshooting through the adjudication platform
• Reviews formulary testing output templates for formulary accuracy
• Supports the creation, maintenance, and validation of client and formulary marketing materials in the formulary management tool
• Conducts adjudication system maintenance data entry activities
• Inputs inactive to active NDC updates
• Supplemental list updates in Medispan for pharmacists to perform quality checks
• Creates non-formulary tier flips in the formulary management tool
• Performs weekly formulary updates for Liberty, Freedom, and standard HIM formularies
• Weekly moratorium updates, and weekly utilization management updates in the formulary management tool
• Performs Monthly Specialty formulary updates in the formulary management tool
• Provides support to Weekly New Drug to Market updates
• Assists with creating job aids for Formulary Operations
• Develops and maintains departmental SharePoint sites
• Completes assigned work plan objectives and projects on a timely basis
• Ensures quality assurance and formulary accuracy
• Support quality improvement projects, as required
• Support RFI and RFP submissions, as required
• Support general business needs and operations, as required
• Performs other duties and responsibilities as needed

Required Qualifications:

• Registered Pharmacy Technician license
• Certification from the National Pharmacy Technician Certification Board or National Health career Association or equivalent experience
• 3-4 years of pharmacy experience working for a health plan or PBM
• Formulary development and maintenance process experience at a PBM or health plan including experience with custom client benefit and formulary design highly preferred
• Proficient in Microsoft office suite with emphasis on Microsoft Excel including advanced Microsoft Excel functions, VBA, macros, etc.
• Experience working with large datasets required
• Knowledge of pharmacy claims processing drug names, and pharmacy/medical terminology

New York, NY Salary Range

$70,000 - $85,000 USD

Denver, CO Salary Range

$70,000 - $85,000 USD

Charlotte, NC Salary Range

$70,000 - $85,000 USD

All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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