Pharmacy Coordinator

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Brief Job Description:

The Specialty Health Pharmacy Coordinator works under the general direction of the Specialty Health Policy and Program Development  Manager.  The Specialty Health Pharmacy Coordinator performs consultative services and technical assistance as part of a team that provides access to services for Texans of all ages with special health care needs that may not qualify for other health care coverage. The Specialty Health Pharmacy Coordinator may consult with and receive scope of work direction from the Policy and Program Pharmacist. 

This role will primarily serve the Kidney Health Care Program (KHC), the Children with Special Health Care Needs (CSHCN) Services Program, and the Hemophilia Assistance Program (HAP), and assists with additional programs across Specialty Health as needed. Assists state staff, pharmacy providers, and program clients to troubleshoot claims and point of sale issues with the pharmacy claims software to ensure clients receive needed prescriptions.  Monitors and analyzes prescription drug usage, prepares reports, makes technical program recommendations for improvements to the Policy and Program Pharmacist. Provides support to Specialty Health pharmacists.  Work is performed under general supervision with moderate latitude for the use of initiative and independent judgment. 

Essential Job Functions (EJFs):

Serves as the subject matter expert for Specialty Health staff, pharmacy providers, Specialty Health program clients, and contracted pharmacy claims vendor for technical assistance on pharmacy claims processing. Works with Specialty Health customer service staff, contracted pharmacies, and clients to troubleshoot issues preventing clients from obtaining prescriptions. Engages with pharmacies, providers, and program clients by phone, in writing, in real time or as follow up to ensure resolution.  Coordinates with Policy and Program Pharmacist and contracted vendor to identify programmatic and technical issues with the pharmacy claims software and submits requests for issue resolution and improvements; follows-up for resolution for submitted requests (25%).

Analyzes drug utilization data for Specialty Health client programs for frequency, availability, drug types, and client utilization. Prepares reports and presentations on drug utilization data for leadership.  Collaborates with program staff in determining trends and provides recommendations for program formulary additions (25%).

Provides training and technical assistance on pharmacy claims processing software and systems processes to program staff and other internal and external stakeholders.  Researches and develops comprehensive training modules, either for in-person, virtual, and hybrid formats as well as corresponding reference materials related to the use of the pharmacy claims software.  Develops and revises procedure manuals related to technical aspects of pharmacy claims and benefits for Specialty Health programs (25%).

Serves as back up to the Specialty Health Eligibility team for real-time updates to client records in claims software for timely pharmacy claims processing in accordance with program policies and procedures. In this capacity, may work with the Policy and Program Pharmacist and act as technical expert between Specialty Health programs and pharmacy claims vendor; ensuring records are updated timely and correctly; monitoring pharmacy claims processing, especially in relation to third party payers, including Medicaid, Medicare, and other third-party prescription drug coverage.  Identifies opportunities for and assists with implementation of process improvement on behalf of programs (20%). 

Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Such participation may require an alternate shift pattern assignment and/or location (5%).

Knowledge, Skills and Abilities (KSAs):

Knowledge of Medicare/Medicaid rules and regulations.
Knowledge of medical and pharmaceutical terms including brand and generic names of medications.
Knowledge of eligibility, enrollment, and pharmacy claims processing systems.

Skill in analyzing and researching complex technical information.
Skill in written and verbal communication, including communication with doctors, nurses, and pharmacy staff.
Skill in resolving problems, in reviewing and evaluating options, and in implementing solutions.
Skill in providing high-quality customer service to clients and pharmacy providers.
Skill in using Word, Excel, Outlook, and other computer applications and databases.
Skill in preparing correspondence, reports and letters.

Ability to work effectively in a team and independently with minimal supervision.
Ability to analyze data and present findings or make recommendations.
Ability to manage time effectively and to exercise good judgment in evaluating situations and making recommendations.
Ability to use the system of record and the CMS portal to verify client drug eligibility.
Ability to interpret and apply rules, regulations, policies, and procedures.

Registrations, Licensure Requirements or Certifications:

Certified Pharmacy Technician (CPhT) in good standing with the Texas State Board of Pharmacy within 12 months of hire.

Initial Screening Criteria:

Graduation from an accredited four-year college or university with major course work in public health, health administration, or a related field.  Experience and education may be substituted on a year-to-year basis.  

A minimum of three (3) years’ experience providing support or assistance to clients related to prescription drug claims. 

Experience interpreting policies and procedures in a healthcare or pharmacy-based environment.  

Additional Information:

This position is eligible for telework consistent with HHSC telework policy, which is subject to change. 

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Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form

Telework Disclaimer:

This position may be eligible for telework.  Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.