Rebate Operations Pharmacist

Prime Therapeutics•Home, WV

10d•$108,000 - $184,000

About The Position

The Rebate Operations Pharmacist provides clinical pharmacy support to the Rebate Operations team and clients. The role interprets and communicates changes in Federal legislation and their effects on State Medicaid Drug Rebate programs, and supports prospective and retrospective Drug Utilization Reviews when requested by a client or to support Account Management. The pharmacist serves as a subject matter expert on the accuracy and reasonableness of medical and pharmacy claims; supports reporting, claims review and adjustment, invoicing, and dispute resolution; and partners with team leadership on implementation decisions, reporting, audits, and contractual requirements. The role monitors CMS and Medicaid Drug Program guidance, recommends ways to integrate changes, and partners with Account Management on rebate trends and client inquiries. Employees must comply with job-specific security responsibilities and controls, as well as applicable legal, regulatory, contractual, and internal requirements. Essential functions must be performed, with reasonable accommodations provided when requested unless doing so would create undue hardship. Prime may change or assign other duties. The position's potential pay range is $108,000 to $184,000, based on experience and skills.

Requirements

PharmD or Bachelor of Science in Pharmacy degree.
Current pharmacist license to practice in the applicable state(s).
At least 1 year of work experience in Pharmacy or Pharmacy Rebate Management.
Must be eligible to work in the United States without work visa or residency sponsorship.
Familiarity with state-specific preferred Drug Lists.
Strong communication, problem-solving, and analytical skills.
Ability to work independently and adapt to a fast-changing environment.
Proficiency in Microsoft Office products, specifically Excel and Word.
Must understand, comply with, and attest to security responsibilities and controls unique to the job, and comply with applicable legal, regulatory, contractual, and internal requirements.
Must be able to perform the essential functions of the job; reasonable accommodations will be made upon request unless they would cause undue hardship.

Nice To Haves

Client-facing experience, including direct communication and relationship management.
Pharmacy Rebate Management experience.

Responsibilities

Serve as a subject matter expert for the Rebate Operations team on the accuracy and reasonableness of medical and pharmacy claims.
Support Rebate Operations and clients in gathering and completing quarterly 64.9r reporting and ad hoc reporting requested by clients to show impacts to rebate programs.
Assist with pre-invoice claims reviews and adjustments and invoicing activities as needed.
Assist with dispute resolution as needed.
Partner with team leadership on implementation decisions related to Federal legislation changes, creation of new reporting, and participation in Federal Office of Inspector General and state audits.
Track and ensure contractual requirements are being met.
Monitor Centers for Medicare & Medicaid Services and Medicaid Drug Program guidance and changes that affect Rebate Operations, and recommend how to integrate changes.
Partner with Account Management on rebate trending discussions, including dispute status, program trends, and invoicing trends.
Serve as the main point of contact for assigned clients on rebate service-related inquiries.
Perform other duties as assigned.