What are the responsibilities and job description for the Pharmacy Benefits Coordinator position at Independent Living Systems?
We are seeking a Pharmacy Benefits Coordinator to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
The Pharmacy Benefits Coordinator plays an essential role in managing and optimizing pharmacy benefit programs. This position is responsible for coordinating with prescribers and targeted beneficiaries to ensure appropriate payment determination, evidence-based drug selection, and resolve medication-related problems. By maintaining accurate records and facilitating communication among stakeholders, the role helps improve member outcomes and control pharmacy-related expenses.
Minimum Qualifications:
- State of Florida Registered Pharmacy Technician License (RPT).
- Experience in managed care pharmacy.
- Strong understanding of pharmacy benefit management, insurance claims processing, and healthcare regulations.
Preferred Qualifications:
- Bachelor’s degree in Health Administration, Pharmacy, Business, or a related field.
- Knowledge of Medicare and Medicaid pharmacy benefit structures.
- Familiarity with data analysis tools and reporting software.
Responsibilities:
- Demonstrate commitment to Our Mission and model ILS Experience Standards of Excellence.
- Identify and resolve basic pharmacy claim rejections (e.g., incorrect billing codes, missing prior authorizations, coordination of benefits issues) with guidance from the pharmacist and respond to inquiries related to formulary status, benefit coverage, and pharmacy processes, ensuring clinical questions are escalated appropriately.
- Spot discrepancies in claims, documentation, or performance metrics and escalate concerns promptly.
- Assist members and providers with benefit‑related questions and support pharmacists and physicians by providing formulary information, benefit details, and documentation needed for coverage determinations while ensuring all clinical inquiries are routed to a pharmacist.
- Maintain accurate documentation in accordance with CMS Part D, Florida Medicaid, and internal health plan requirements.
- Support compliance activities, including policy updates, letter reviews, formulary updates, coverage changes, and audit preparation.
- Assist in preparing structured reports for CMS submissions, Medicaid reporting, quality initiatives, and internal reviews.
- Maintain organized files, data sources, and supporting documentation for audits and presentations.
- Collaborate with case management, utilization management, quality improvement, and other teams to support integrated care for members.
- Participate in workflow improvements and process enhancement initiatives.
- Conduct outreach to pharmacies, members and providers for DUR campaigns, MTM follow‑ups, adherence initiatives, and other quality programs.
- Perform all other duties as assigned.