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Job Summary
Located in Chicago, IL or Richardson, TX and reporting into the Pharmacy Division this position is responsible for managing Medical Drug Cost by developing and implementing reimbursement strategies. Medical drug management reporting and contract management which includes medical drug specific modeling activities, contract pricing, management and maintenance; claims review for accuracy and trending purposes; coordinating market research and development of new reimbursement methodologies and/or new reimbursement types; recommending, initiating or writing appropriate system change requests ; verifying testing results and approved changes for production; providing documentation and training associated with the pricing system and changes or modifications; interfacing with divisions which impact the pricing aspects of the claims processing system; ensuring files are constructed and maintained; and coordinating activities with others to ensure accurate and consistent claim pricing and database maintenance/required system support and funding system enhancements and testing and financial review and analysis of new or proposed payment methods.Requirements:
* Bachelor degree and 3 years management experience or supervisory experience with demonstrated leadership abilities and sound decision-making.
* 4 years experience in medical drug claims and/or claims related role requiring problem identification with analysis, documentation, and solutioning.
* Knowledge of rebatable, non-rebatable drugs, ASP calculations, ICD-9, CPT-4 and/or HCPCS.
* Verbal and written communication skills to interact with various internal and external sources.
* Initiative, be a self-starter, and have good analytical abilities.
* Organizational skills.
Preferred Requirements:
* Experienced Medical drug specific modeling.
* Experience with impact modeling and pricing proposals.
* Develop dashboards and complex models for monitoring and evaluating impact.
* Contract pricing, management and maintenance; claims review for accuracy and trending purposes.
Sponsorship is not provided at this time.
Relocation is not provided at this time.
This position is a flex arrangement, requires reporting into the office 3 days per week and will allow up to 2 days working from home.
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HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
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