ACARA Jobs

Acara Solutions is seeking Pharmacy Systems Coordinators for our client in Williamsville, NY!

In this role, you will support the maintenance and administration of pharmacy systems to ensure accurate adjudication of prescription claims and reliable pharmacy benefit information for members and stakeholders. This position works closely with internal teams to maintain benefit designs, resolve system inquiries, support claims processing, and assist with documentation and training efforts.

We are seeking qualified candidates with:

• Pharmacy experience supporting claims processing or pharmacy systems
• Strong attention to detail and ability to manage complex data and documentation
• Strong communication and collaboration skills across cross-functional teams

Here's what you'll do:

• System Administration and Maintenance: Assist with maintenance of RxClaim functionality as it pertains to all lines of business. Attend assigned MOD review meetings, test and/or review SR's assigned for MOD implementation and assist with installation tasks on MOD night. Communicate problem defects to Pharmacy Systems Specialist along with detailed documentation and associated testing scenarios. Ensure reliable interfacing with the HealthRules system, and other support systems. Responsible for maintenance of the RxAuth application.
• Benefit and Formulary Administration: Build benefit plans in the RxClaim system to ensure pharmacy claims process according to the design of the product. Responsible for assigned primary or secondary testing for all plan builds or updates, including tests to confirm administration accuracy and consistency. Maintain and follow the documented drug change process for formulary updates within set time frames and with accuracy within the policy. This includes reporting issues or questions to the Pharmacy Systems Specialist. Responsible for the maintenance of all eligibility files for all lines of business, including but not limited to updating person codes, dual eligible members, UOI updates, staging/loading files, and updating monthly eligibility logs. Provide support and assist with process improvements. Participate in any ad-hoc projects as needed.
• Claims Management and Payment: Responsible for daily review of the payment process in RxClaim, including but not limited to reviewing reports and resolving any associated issues. Monitor and validate claims for processing accuracy. Participate as the Detective of the Day to handle help desk issues. Escalate all unresolved issues to the Pharmacy Systems Specialist. Also responsible for build and testing of new pharmacies, pharmacy pricing and QA-ing client pricing. Complete processing of file loads needed for claims management. Assist with any ad-hoc projects as needed.
• Training and Documentation: Assist with the creation or revision of all training documentation, policies and procedures. Ensure that documentation accurately reflects system functionality, industry best practices, and are appropriate, current, and well organized. Also accountable for the training and mentoring of associates.

Position Type: Direct Placement

Pay: Up to $25/hr. **Based on experience

Schedule: M-F 8:00AM-4:30PM **Fully Onsite during training – will transition to Hybrid once training is complete

About Acara Solutions

Acara is a premier provider of recruiting and workforce solutions-we help companies compete for talent. With a legacy of experience in a variety of industries around the world, we partner with clients, listen to their needs, and customize visionary talent solutions that drive desired business outcomes. We leverage decades of experience to deliver contingent staffing, direct placement, executive search, and workforce services worldwide.