Position Summary:

We are seeking a detail-oriented and analytical Manager, Pharmacy Pricing Appeals to join our Provider Relations team. In this role, you will be responsible for managing and resolving the interaction with the pharmacies related to pricing appeals and claims review requests submitted by the pharmacies or internal teams. This includes performing an initial review of the claim and associated pricing, providing the information to internal teams for review, managing any claim adjustments that may be needed, and communicating any necessary information back to the pharmacies. You will play a critical role in ensuring fair reimbursement practices and maintaining strong relationships with pharmacy partners. 

Position Responsibilities:

• Lead the review and improvement of the pharmacy pricing appeal process in coordination with the Analytics team.
• Lead the review and evaluation of the pricing appeal regulatory requirements with the Legal team.
• Manage intake pharmacy pricing appeals or claims reviews from the pharmacies or internal teams via the applicable intake methods required by internal processes and regulations. This involves managing applicable appeal in-boxes and intake methods.
• Evaluate pharmacy-submitted appeals to ensure they meet established criteria and provide the applicable information to the appropriate internal teams for review.
• Receive the internal claim pricing review and respond to the appealing pharmacy with the information.
• Manage the internal process to update any pricing or make claim adjustments as necessary.
• Collaborate with pharmacies and internal teams to reach equitable reimbursement outcomes.
• Provide appeal response information and feedback to the pharmacies as required.
• Provide clear and timely updates to pharmacies and other stakeholders regarding appeal statuses and outcomes.
• Maintain accurate records of appeals and generate reports on trends and discrepancies.
• Lead the development of and manage the claims review process at the NDC level.
• Support other projects as assigned by the Provider Relations team.
• Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance.

Minimum Qualifications:

• Bachelor’s degree required.
• 5+ yrs. of experience in reviewing claims or payment appeals in healthcare, pharmacy, PBM, or other relevant experience. Such prior experience in a pharmacy pricing appeals role includes experience in managing regular correspondence and communication with pharmacies.
• In-depth knowledge of pharmacy operations and drug pricing.
• Familiarity with PBMs and their role in pharmacy reimbursement.
• Strong analytical and problem-solving skills.
• Strong project management skills.
• Excellent communication and interpersonal abilities.
• Experience with and understanding of pharmacy claims processing, pharmacy adjudication systems, and reimbursement workflows.
• Knowledge of state or federal pricing appeal laws.
• Intermediate level of proficiency with Microsoft Excel, Word, PowerPoint.
• Proven track record of working in a fast-paced environment, managing multiple tasks at once and having a go-get attitude to provide persistent outreach to pharmacy providers to close out contracts and tasks.
• Ability to work independently, track work/projects appropriately and remain on task.
• Strong communication skills with the ability to develop effective working relationships with providers and internal and external stakeholders.

Preferred Qualifications:

• Certification in pharmacy technician or related field is a plus.

Join Our Growing Physical Therapy Team at Independence Veterinary Clinic!

Salary: $22.00 - $24.00 per hour (based on skills and experience.) $1,500 Sign-on Bonus!

Schedule: Tuesday- Friday 8 AM-6PM

Must be CCRT or CCAT certified or equivalent

Independence Veterinary Clinic’s physical therapy division, HealingPups, is growing rapidly and hiring a Physical Therapy Veterinary Technician! Our facility boasts state-of-the-art rehabilitation equipment, including a modern underwater treadmill, advanced laser therapy, and a full-sized indoor swimming pool—designed for therapeutic exercise, obesity management, and just plain doggy fun.

Our PT program is led by Dr. Amy Benjamin and Dr. Blair Keffer, both licensed rehabilitation veterinarians with extensive experience in neurological, orthopedic, and general rehab cases.

Learn more about our work at: www.HealingPupsCharlotte.com

What to Expect

As you join our mission, expect to be supported in your work and home life with

• All the benefits you deserve—medical, dental, vision, retirement for full-time employees
• Paid time off. Take the time you need to recharge. For full-time employees.
• Employee pet discount because we know your pets are family, too.
• 401(k) with a generous company match to help you invest in your future while you care for pets today.
• Employee referral bonus. Earn $1,000 when you refer a new team member to one of our 180+ partner hospitals across the country.
• Continuing education opportunities for our licensed technicians to grow and thrive in their careers

 Key Responsibilities

• Client communication: Update owners on patient progress, home care plans, and medications. Answer rehab-related questions and collaborate with PT doctors or veterinarians for more complex cases.
• Client Education: Teach clients about PT goals, exercises, recovery expectations, and how to use therapy tools like laser treatments and underwater treadmills.
• Customer Service: Provide a warm, friendly experience from check-in to discharge. Foster trust and promote our rehab services to pet owners.
• Animal Handling & Therapy Support: Safely assist in hydrotherapy, laser sessions, land-based exercises, and other rehab techniques. Monitor pets during sessions and adjust care as needed.
• Facility & Equipment Care: Clean and maintain therapy rooms, equipment, and the rehab pool. Ensure a safe and inviting environment.
• Record Keeping: Accurately document each therapy session and maintain clear notes on progress and follow-up care.
• Pharmacy Support: Prepare and administer medications related to PT, including pain management protocols and supplements.
• Safety & Technical Skills: Adhere to safety standards and rehab protocols. Understand animal biomechanics and movement to support proper recovery and performance.

Qualifications

• Minimum 1 year of veterinary technician experience
• must be CCRT or CCAT certified or equivalent
• Skilled in safe, compassionate animal handling
• Knowledge of common disease states and the ability to recognize changes in patient condition
• Familiarity with DEA, OSHA, and veterinary safety protocols
• Experience in physical rehabilitation or a strong interest in learning is preferred

About Independence Veterinary Clinic

At Independence Veterinary Clinic, we provide personalized, compassionate care that puts pets and their families first. Our mission is to deliver exceptional medical, surgical, and preventative services while creating a warm, welcoming environment. We focus on building trust with our clients through education and support, and we prioritize the well-being of every animal we treat.

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