BostonRecruiter Since 2001
the smart solution for Boston jobs

Drug Reimbursement Specialist I - Remote

Company: UnitedHealth Group
Location: Boston
Posted on: March 20, 2023

Job Description:

Opportunities at Change Healthcare, part of the Optum family of businesses. We are transforming the health care system through innovative technology and analytics. Find opportunities to make a difference in a variety of career areas as we all play a role in accelerating health care transformation. Help us deliver cutting-edge solutions for patients, hospitals and insurance companies, resulting in healthier communities. Use your talents to improve the health outcomes of millions of people and discover the meaning behind: -Caring. Connecting. Growing together.------ -

This position must develop new pricing for pharmacy providers and sometimes there is no reference pricing (AWP, WAC, NADAC) to go on with new products. This position does additional research such as competitor pricing and manufacturer list pricing to calculate a go out reimbursement rate for providers. This position then monitors claims for this product as well as provider dispute information until reference pricing is available to calculate a more reference based reimbursement;

Innovation: This role should continuously look for opportunities to streamline and to recommend to leadership more efficient ways to perform their daily tasks, but developing these opportunities is not necessarily a responsibility.

Judgement and Decision Making: Financial impact to both client health plans and pharmacy providers for balancing proper drug reimbursement structure of both providing savings to the health plan and fair reimbursement to the pharmacy providers.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities: -

  • Interacts with customers and is the first point of contact for pharmacy providers for drug pricing for both Medicaid programs and commercial PBM/PBS lines of business
  • Forwards provider dispute information to Medicaid program contacts and works with Network Oversight leadership for commercial PBM/PBS pricing disputes
  • Receives Medicaid program responses to provider disputes and updates corresponding drug pricing databases when applicable
  • Communicates resolution/decision of both Medicaid and PBM/PBS drug pricing disputes directly with corresponding provider
  • Enters new pricing into point-of-sale system when applicable
  • Staffs provider drug pricing help desk call center for applicable Medicaid programs as well as answers inquiries through the PBM/PBS drug pricing inquiry e-mail mailboxes
  • Collecting and entering monthly survey acquisition cost data into spreadsheets with accuracy
  • Compiles and Disseminates Provider Inquiry and Response Data to Industry Relations Leadership
  • Using internal databases, and after collecting inquiries from providers and responses from Medicaid plans, this role provides summarized data for Industry Relations leadership to identify trends and opportunities of both SMAC and commercial PBM/PBS lines of business

    You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. -
    Required Qualifications: -

    • High School Diploma / GED (or higher) or equivalent work experience
    • 2+ years of customer service experience and/or phone/contact center experience in retail or LTC pharmacy settings or PBM experience
    • Proficiency in MS Office applications, specifically MS Excel and MS Access
    • Knowledge of prescription drug industry
    • Demonstrated excellent interpersonal, collaboration and communication skills
    • Proven ability to multi-task for extended periods of time, including managing inquiries while also navigating multiple computer systems
    • Solid math/accounting skills
    • Working knowledge of drug reference pricing (AWP, WAC, NADAC, etc.)

      Careers with Optum. -Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges. -

      *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. -

      California, Colorado, Connecticut, Nevada, New York, Rhode Island, or Washington Residents Only: -The hourly range for California, Colorado, Connecticut, Nevada, New York, Rhode Island or Washington residents is $16.00 to $31.44. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. - -

      At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. - - - -

      Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. -

      UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. -

Keywords: UnitedHealth Group, Boston , Drug Reimbursement Specialist I - Remote, Other , Boston, Massachusetts

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category

Log In or Create An Account

Get the latest Massachusetts jobs by following @recnetMA on Twitter!

Boston RSS job feeds