Rebate Operations Pharmacist

Prime Therapeutics; Providence (RI); On-site; USD 108,000 - 184,000; Full time

Job summary

Prime Therapeutics, located in Providence, RI, is seeking a Rebate Operations Pharmacist to support the Rebates team and clients. The role interprets federal legislation changes and their impact on state Medicaid drug rebates, and supports DRU/retro-DRU reviews as required by clients.

Responsibilities include acting as SME for rebates, assisting with quarterly 64.9r reporting, invoicing adjustments, and maintaining compliance with CMS guidance and audits.

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

Responsibilities

• Act as SME 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
• Assist in pre-invoice claims reviews and adjustments and invoicing activities; assist in dispute resolution
• Partner with team leadership in implementation decisions regarding Federal legislation changes and new reporting
• Monitor CMS and Medicaid Drug Program guidance for changes and provide recommendations
• Partner with Account Management to support rebate trending discussions and client inquiries
• Other duties as assigned

Skills

Communication skills

Problem-solving

Analytical skills

Independent work

Adaptability

Education

PharmD or BS Pharmacy

Tools

Microsoft Office (Excel, Word)

Job description

Home

Full time

R-17509

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 (https://www.primetherapeutics.com/benefits) and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

Prime Therapeutics LLCis 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.

At Prime Therapeutics (Prime), we are a different kind of PBM. We’re reimagining pharmacy solutions to provide the care we would want for our loved ones. That purpose energizes our team and creates limitless opportunities to make a difference.

We know that people make all the difference. If you’re ready for a purpose-driven career and are passionate about simplifying health care, let’s build the future of pharmacy together.

Prime Therapeutics LLCis 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 torace, 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.

If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at email [e-mail].