Rebate Operations Pharmacist—Clinical & Regulatory SME

Prime Therapeutics; Helena (MT); On-site; USD 108,000 - 184,000; Full time

Job summary

Prime Therapeutics seeks a Rebate Operations Pharmacist to provide clinical pharmacy support for the Rebate Operations team and clients. The role involves interpreting federal legislation changes and their impact on State Medicaid Drug Rebate programs, and supporting pro-Drug Utilization Review activities as required.

Responsibilities include serving as SME for claims accuracy, assisting with quarterly reporting and invoicing, coordinating with leadership on compliance and audits, and monitoring

Qualifications

• PharmD or BS in Pharmacy required.
• 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) 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

Education

PharmD or BS Pharmacy degree

Current Pharmacist license to practice in applicable state(s)

Job description

Prime Therapeutics seeks a Rebate Operations Pharmacist to provide clinical pharmacy support for the Rebate Operations team and clients. The role involves interpreting federal legislation changes and their impact on State Medicaid Drug Rebate programs, and supporting pro-Drug Utilization Review activities as required.

Responsibilities include serving as SME for claims accuracy, assisting with quarterly reporting and invoicing, coordinating with leadership on compliance and audits, and monitoring