About this opportunity
Capital Rx lists this Medical Coding Specialist opportunity in new york, New York. Review the employer’s description below for duties, qualifications and application requirements.
Job description
About Judi Health
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:
Judi Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,
Judi Health, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and
Judi, the industry's leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.
Together with our clients, we're rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit
Position Responsibilities:
Supportsthe 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 nd implementing custom client formulary and benefit requests within the formulary management and adjudication platform
Triages and assists with Salesforce casesfor 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 thepharmacists with cross functional support for claim troubleshooting through the adjudication platform
Reviewsformulary testing output templates for formulary accuracy
Supportsthe creation, maintenance,and validation of client andformulary marketing materialsin theformularymanagement tool Conducts adjudication system maintenance data entry activities
Inputs inactive to active NDC updates
Supplemental list updates inMedispanfor pharmacists to perform quality checks
Createsnon-formulary tierflips in the formulary management tool
Performs weekly formulary updates for Liberty, Freedom, and standard HIMformularies
Weekly moratorium updates, andweekly utilization managementupdatesin the formulary management tool
Performs Monthly Specialty formulary updatesin the formulary management tool
Provides support to Weekly New DrugtoMarket updates
Assists withcreating jobaids for Formulary Operations
Develops and maintains departmental SharePoint sites
Completes assigned work plan objectives and projects on a timely basis
Ensuresquality 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 theNationalPharmacy 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 MicrosoftExcel 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.
By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at
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Worksite address
new york, NY, 10261, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.