Rebate Operations Pharmacist

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

Job Posting Title

Rebate Operations Pharmacist

Job Description

The Rebate Operations Pharmacist is responsible for clinical pharmacy support to Rebate Operations team and clients. This role follows, interprets, and communicates Federal legislation changes and their impacts on State Medicaid Drug Rebate programs. This role supports pro-Drug Utilization Review/retro-Drug Utilization Reviews as required by client or to support Account Management.

Responsibilities

Act as Subject Matter Expert (SME) resource for Rebate Operations team regarding accuracy and reasonableness of medical and pharmacy claims

Support Rebate Operation and clients in gathering and completion of quarterly 64.9r reporting and ad hoc reporting at client request that aid in showing impacts to rebate programs; assist in pre-invoice claims reviews and adjustments and invoicing activities as needed; assist in dispute resolution as needed

Partner with team leadership in implementation decisions regarding Federal legislation changes, new reporting creation, and participation in Federal Office of Inspector General (OIG) and state audits; track and ensure all contractual requirements are being met

Monitor Centers for Medicare & Medicaid Services (CMS) and Medicaid Drug Program (MDP) for new guidance and changes that impact Rebate Operations; provide recommendations on integrating changes

Partner with Account Management to support rebate trending discussions (e. g., disputes status, program and invoicing trends) and serve as main point of contact for assigned clients on all rebate service-related inquiries

Other duties as assigned

Minimum Qualifications

• PharmD or Bachelor of Science Pharmacy degree
• Current Pharmacist license to practice in the applicable state(s)
• 1 year work experience in Pharmacy or Pharmacy Rebate Management

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

• Familiarity with State specific preferred Drug List
• Strong communication, problem solving and analytical skills required
• Ability to work independently and to adapt to a fast changing environment
• Proficiency in Microsoft Office product suite, specifically Excel and Word

Preferred Qualifications

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

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

Potential pay for this position ranges from $108,000.00 - $184,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.