Pharmacy Test Implementation Lead

Regular
Exempt

GENERAL DESCRIPTION:
Responsible for developing the test plan, conducting, and monitoring the testing of drug lists, pharmacy benefits, and medical components prior to the effective date for all company business lines. Ensures that the coding on the Pharmacy Benefit Management (PBM) adjudication platform for drug listings is accurate as specified in the implementation documents.
ESSENTIAL FUNCTIONS:
• Designs and coordinates the test plan to ensure it is aligned with the implementation process work plan as well as with the validation of the management.
• Define and create necessary test cases, along with their expected benefits for defined scenarios, and develop test scenarios, including expected results and lists to be used for each scenario. Create, upload, and analyze various files to perform automated test exercises on the PBM platform, and reconcile and evaluate completed test files, providing progress reports to the management.




• Implement initiatives to optimize resources and reduce errors during the testing period and for special initiatives. Report to management any situation that could put the defined plan in jeopardy.
• Identify and report any findings or coding errors to the Specialist and the PBM team, ensuring a prompt response to the reported issues. Actively participate in discussions and follow up with the PBM regarding these findings and coding errors, and collaborate with the Specialists to implement corrections.
• Collaborates with management in preparing an internal testing plan for the modifications of the current pre-authorizations that cross the calendar year, updated by the PBM for the drugs that suffered changes.
• Conducts test claims on the updates of MediSpan for pharmacy and medical components, and test claims on the updates of formularies and benefits for all company business lines. Also, conducts claim tests of the changes requested to the PBM or changes requested by the regulations o

📌 Pharmacy Test Implementation Lead (San Juan)
🏢 MCS Healthcare Holdings, LLC (MCS)
📍 San Juan