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Pharmacy Benefit Manager |
Career OverviewA pharmacy benefits manager is responsible for the crucial financial aspects of prescriptions and health care. Pharmacies submit bills for prescriptions to the pharmacy benefit manager and it is the benefit manager’s job to review the information relevant to the bill and determine who should pay what amount to cover the cost of the medication.
In most cases, pharmacy benefit managers review complex information about an individual’s prescription drug coverage by medical insurance agencies and state sponsored programs created to cut the cost of prescription medication. Many pharmacy benefit managers combine backgrounds in accounting with acquired knowledge of pharmaceuticals and the health care system.
They issue payment for prescriptions directly to pharmacy providers and review claim information relating to medical insurance programs, which may or may not affect the amount of money owed by the pharmacy and by the patient for any given item.
The nature of the work determines that pharmacy benefit managers must be experts in accounting, pharmacy procedures, and in health insurance programs and protocols. It also requires a readiness to spend substantial time in an office environment and demands heavy phone use. Familiarity with pharmacy-related software programs, with accounting software programs, and with health insurance billing systems is essential.
Most pharmacy benefit managers are hired by insurance companies or medical groups. Although most of the work requires individuals to follow established protocols and programs, there are some opportunities to exchange ideas and research best practices to drive marketplace changes, improve pharmacy benefits, and control the cost of prescription drugs.
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Career RequirementsA two-year degree or the equivalent experience in business is required for most pharmacy benefit manager positions, often with an additional two years experience in claims processing at entry-level may also be required or preferred in many cases.
To function, pharmacy benefit managers are required to read, analyze and interpret procedures, design plans, and implementation forms relating to health insurance and pharmacy drug coverage plans.
They must be comfortable presenting to clients, management, and other associates within the converging businesses of pharmacies and insurance companies. They must also be affective at writing reports and other business correspondence and organizing their schedules and files to function to the best of their ability.
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Job OutlookFor those with either extensive experience or advanced degrees, a career as a pharmacy benefit manager certainly promises to be rewarding and dynamic.
The health care industry in the United States is expected to change dramatically in the coming years, as the economy changes and as the population of the country changes, with the percentage of elderly citizens expected to grow dramatically over the next decade.
With these changes fast being realized, forecasters certainly predict positive developments in the job market for pharmacy benefit managers. For the most part, job growth is expected to be good and there are also expected to be a number of opportunities for advancement in administration, education, policy-making, and research relating to pharmacy benefits. These advanced positions will be available to qualified candidates.
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Career TrackMost pharmacy benefit managers have a strong background in accounting and business. They typically have either substantial experience or at least an Associate’s degree in a field relating to business practice. They generally have some training as an accountant and often undertake on-the-job training to familiarize themselves with insurance policies and protocols.
Advancement is typically to supervisory positions, although candidates with interest in administration, education, research, or policy-making aspects of pharmacy benefits management may also find ready opportunities.
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CompensationThe typical salary for a pharmacy benefits manager is between $40,000 and $60,000 per year, depending on experience and training. Pharmacy technicians may find employment through insurance companies and state to national health care organizations.
As the job does not require training or certification, most new entry positions are filled quickly. Although job growth is reasonable, the best opportunities are available for those with advanced training.
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