SmithRx

Formulary Operations Specialist

SmithRx

full-time

Posted on:

Location Type: Remote

Location: United States

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About the role

  • Execute complex formulary coding within adjudication systems, ensuring clinical intent is accurately reflected in system logic.
  • Utilize Advanced Excel and Google Sheets (VLOOKUP, Index/Match, Pivot Tables, and complex nested formulas) to manipulate large datasets.
  • Apply deep knowledge of PBM hierarchies and adjudication logic to troubleshoot rejected claims and optimize system performance.
  • Manage multiple high-priority projects simultaneously, shifting priorities fluidly to meet urgent client needs or business deadlines.

Requirements

  • Minimum of 2 years of direct experience in a PBM or Managed Care environment.
  • Having an active Pharmacy Technician license or registration is highly preferred.
  • Expert-level capability in Excel and Google Sheets, specifically for data cleaning, transformation, and complex formula building.
  • Proven experience in formulary management systems and a strong grasp of adjudication coding and hierarchy structures.
  • Deep knowledge of Medispan drug information or similar drug database platforms.
  • Analytical Thinking: Exceptional critical thinking skills and the ability to solve complex problems independently.
  • Detail Orientation: Meticulous attention to detail when managing high-stakes data updates.
  • Adaptability: The ability to thrive and remain composed in a demanding, constantly evolving landscape.
  • Project Management: Strong organizational skills with the ability to manage timelines and prioritize tasks according to business and client urgency.
  • Systems Thinking Mindset: The ability to look beyond the immediate task to understand how system updates ripple through the entire system.
Benefits
  • Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance
  • Flexible Spending Benefits
  • 401(k) Retirement Savings Program
  • Short-term and long-term disability
  • Discretionary Paid Time Off
  • Paid Company Holidays
  • Wellness Benefits
  • Commuter Benefits
  • Paid Parental Leave benefits
  • Employee Assistance Program (EAP)
  • Well-stocked kitchen in office locations
  • Professional development and training opportunities
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
formulary codingadjudication logicdata cleaningdata transformationcomplex formula buildingformulary management systemsadjudication codingMedispanExcelGoogle Sheets
Soft Skills
analytical thinkingdetail orientationadaptabilityproject managementorganizational skills
Certifications
Pharmacy Technician license