Clinical Program Director
New Today
A growing healthcare technology organization is seeking a Clinical Program Director of Formulary to oversee the accurate and timely implementation of formulary data across medical benefit drugs, DMEPOS, immunizations, vaccinations, and test-and-treat services. This role ensures fee schedules and coding data are complete, compliant, and optimized for claims processing.
Please double check you have the right level of experience and qualifications by reading the full overview of this opportunity below.
Key Responsibilities
Lead the review, update, and maintenance of formulary files and fee schedules.
Ensure compliance with federal/state payer rules and policies.
Act as subject matter expert in coding (HCPCS, CPT, NDC, ICD-10).
Oversee quality checks, pricing validations, and data accuracy.
Collaborate with internal teams and external partners to align systems and workflows.
Monitor regulatory updates and recommend system or process changes.
Qualifications
7–10 years of healthcare experience, with 5+ years in formulary or benefit management.
Strong knowledge of claims adjudication, reimbursement operations, and coding standards.
Advanced Excel skills (pivot tables, lookups, reconciliations).
Coding certifications (CPC, CCS, CMRS) preferred.
Detail-oriented with strong analytical and communication skills.
- Location:
- Dallas, TX
- Job Type:
- FullTime
- Category:
- Healthcare And Medical