Pharmacy Benefits Specialist III

SummaCare - 1200 E Market St, Akron, OH 

Full-Time / 40 Hours / Days

*Hybrid after training

Summary:
Monitors Pharmacy Benefits Manager (PBM) activities related to all lines of business, including Medicare Part D, Commercial and MarketPlace. Serves as a Subject Matter Expert (SME) for all pharmacy benefit questions, concerns, and issues from internal and external customers. Positions self as the lead Pharmacy Benefits Specialist within the department by supporting and directing Pharmacy Benefits Specialists II positions. Researches, identified issues and works to resolve. Supports new benefit design, benefit build, testing, and implementation of market competitive, cost effective, quality-based drug benefits which meet applicable federal and state regulatory requirements. Performs CMS required analysis of daily denied claims, coverage determinations, hospice and end stage renal disease (E...