Manager, Pharmacy Pricing Appeals

Capital Rx

Remote
$95,000—$130,000 usd; not specified; not specified...
Remote
Pharmacy pricing appeals
Claims review requests
Pharmacy operations knowledge
Capital Rx is seeking a Manager for Pharmacy Pricing Appeals to join their Provider Relations team, responsible for managing pharmacy interactions related to pricing appeals. The ideal candidate should possess extensive experience in claims review within the healthcare or pharmacy sectors and have strong analytical and communication skills

Job Summary

  • Manage and resolve interactions with pharmacies related to pricing appeals and claims review requests, ensuring fair reimbursement practices and maintaining strong relationships with pharmacy partners.
  • Lead the review and improvement of the pharmacy pricing appeal process in coordination with the Analytics team and evaluate regulatory requirements with the Legal team.
  • Maintain accurate records of appeals, generate reports on trends and discrepancies, and collaborate with pharmacies and internal teams to reach equitable reimbursement outcomes.

Matching Summary

Match Score: 85

Capital Rx is seeking a Manager for Pharmacy Pricing Appeals to join their Provider Relations team, responsible for managing pharmacy interactions related to pricing appeals. The ideal candidate should possess extensive experience in claims review within the healthcare or pharmacy sectors and have strong analytical and communication skills.

Salary

$95,000—$130,000 USD; Not specified; Not specified

Skills & Requirements

Must-have

  • pharmacy pricing appeals
  • claims review requests
  • pharmacy operations knowledge
  • PBM reimbursement workflows
  • Microsoft Excel proficiency

Nice-to-have

  • rebuilding trust in healthcare
  • enterprise health platform
  • go-get attitude
  • equitable reimbursement outcomes

Key Requirements

  • Bachelor's degree required
  • 5+ years experience in healthcare/pharmacy appeals
  • Knowledge of state or federal pricing appeal laws
  • Proven track record in fast-paced environment

Work Rights

Not specified

Tailored Resume

Cover Letter