Pharmacist, Rebate Operations & Compliance

Prime Therapeutics; Lansing (MI); On-site; USD 108,000 - 184,000; Full time

Job summary

Prime Therapeutics is seeking a Rebate Operations Pharmacist to provide clinical pharmacy support to the Rebate Operations team and clients. The role interprets federal legislation changes affecting state Medicaid Drug Rebate programs and supports DRU/retro-DUR reviews as required by clients or Account Management.

Responsibilities include SME guidance on accuracy of medical and pharmacy claims, assisting in quarterly 64.9r reporting, invoicing and dispute resolution, and coordinating with

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.

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

Skills

Strong communication

Problem solving

Analytical skills

Education

PharmD or Bachelor of Science Pharmacy degree

Tools

Microsoft Excel

Microsoft Word

Job description

Prime Therapeutics is seeking a Rebate Operations Pharmacist to provide clinical pharmacy support to the Rebate Operations team and clients. The role interprets federal legislation changes affecting state Medicaid Drug Rebate programs and supports DRU/retro-DUR reviews as required by clients or Account Management.

Responsibilities include SME guidance on accuracy of medical and pharmacy claims, assisting in quarterly 64.9r reporting, invoicing and dispute resolution, and coordinating with