OPUS - Formulary File Liaison

Job description

IBM Global Business Services (GBS) is a team of business, strategy and technology consultants enabling enterprises to make smarter decisions and providing unparalleled client and consumer experiences in cognitive, data analytics, cloud technology and mobile app development. With global reach, outcome-focused methodologies and deep industry expertise, IBM GBS empowers clients to digitally reinvent their business and get the competitive edge in the cognitive era in over 170 countries. Bottom line? We out think ordinary. Discover what you can do at IBM.

ROLES & RESPONSIBILITIES:
·  Formulary File liaison shall be available within twenty-four (24) hours of a request from the Department for verbal consultation to Department-designated personnel, and within forty-eight (48) hours of a request for face-to-face interaction with Department-designated personnel.
·  Maintaining and updating a log of all inquiries that lists problems, discrepancies, and/or questions regarding the Formulary File and diligently pursue the resolution of any problem statements related to the Formulary File.
·  Attending weekly Problem Correction Status (PCS) meetings.
·  Serving as a bridge between Department and IT M&O teams to achieve prompt resolution of problems related to the Formulary File.
·  Participating in all walkthroughs for SDNs that have an impact or potential impact to the Formulary File.
·  Provide input to the Business Operations Vendor's PRO team, to have them inform all users of the Formulary File regarding any problems and/or SDNs that may have an impact to the Formulary File, as directed by the Department.
·  Supply appropriate lists of manufacturers and package size modifications for applicable drugs.
·  Inform all users of the Formulary File regarding any problems and/or SDNs that may have an impact to the Formulary File, as directed by the Department.
·  Provide FAC pricing related updates.
·  Adopt policy to add or delete drugs or medical supply items from the Maximum Allowable Ingredient Cost/Maximum Allowable Product Cost (MAIC/MAPC) list and to change the referenced product for drugs and medical supplies included on the list. The Department shall approve MAIC/MAPC price changes to be applied in the next update cycle and shall approve the bulletin information announcing the changes for timely distribution to providers.
·  Notify DHCS of any additions, deletions, or changes to the Procedure, Diagnosis, and Formulary File.

BENEFITS
Health Insurance. Paid time off. Corporate Holidays. Sick leave. Family planning. Financial Guidance. Competitive 401K. Training and Learning. We continue to expand our benefits and programs, offering some of the best support, guidance and coverage for a diverse employee population. https://www-01.ibm.com/employment/us/benefits/2019_Benefits_and_HR_Programs.pdf

CAREER GROWTH
Our goal is to be essential to the world, which starts with our people. Company wide we kicked off an internal talent strategy program called Go Organic. At our core, we are committed to believing and investing in our workforce through: Skill development: helping our employees grow their foundational skills Finding the dream job at IBM: navigating our company with the potential for many careers by channeling an employee's strengths and career aspirations Diversity of people: Diversity of thought driving collective innovation

CORPORATE CITIZENSHIP
With an employee population of 375,000 in over 170 countries, amazingly we connect, collaborate, and care. IBMers drive a corporate culture of shared responsibility. We love grand challenges and everyday improvements for our company and for the world. We care about each other, our clients, and the communities we live, work, and play in!
http://www.ibm.com/ibm/responsibility/initiatives.html http://www.ibm.com/ibm/responsibility/corporateservicecorps

CAMMIS

Auto req ID

208555BR
Required Education

High School Diploma/GED
Role ( Job Role )

Business Analyst
State / Province

CALIFORNIA
Primary job category

Technical Specialist
Company

(0147) International Business Machines Corporation
Contract type

Regular
Employment Type

Full-Time
Is this role a commissionable/sales incentive based position?

No
Travel Required

No Travel
IBM Business Group

GBS
Preferred Education

Bachelor's Degree
City / Township / Village

SACRAMENTO
EO Statement

IBM is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. IBM is also committed to compliance with all fair employment practices regarding citizenship and immigration status.
Required Technical and Professional Expertise

·  BASIC EDUCATION: You must be a high school graduate or have a general education development certificate equivalent.
·  One of the following Certificates: Affidavit of Completed Coursework or Graduation, Pharmacy Technician Certification Board (PTCB) certified, National Healthcare Association Pharmacy Technician Certification Program, or Military Training
·  Two (2) year's experience in medical billing and claims payment. It is desirable, but not required for the two (2) years of experience to be CA-MMIS experience
·  Knowledgeable with claims processing, quality management, the drug and medical supply data Trained in Formulary File operations
Country/Region

United States
Preferred Technical and Professional Experience

·  Previous Healthcare experience
Secondary Job Category

Services Specialist
Eligibility Requirements

·  None
Position Type

Professional
Early Professional Track

Not Applicable - Professional Hire