Manager, Pharmacy Pricing Appeals (Medtech)

TL;DR

Manager, Pharmacy Pricing Appeals (Medtech): Managing and resolving pharmacy interactions regarding pricing appeals and claims review requests with an accent on fair reimbursement practices and regulatory compliance. Focus on optimizing the appeal process, evaluating regulatory requirements, and coordinating with internal analytics and legal teams.

Location: Remote or Hybrid (Must be based in the US; offices in Charlotte, Denver, New York)

Salary: $95,000 - $130,000 USD

Company

hirify.global is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans to rebuild trust in US healthcare.

What you will do

• Lead the review and improvement of the pharmacy pricing appeal process in coordination with Analytics.
• Manage the intake and evaluation of pricing appeals and claims reviews from pharmacies and internal teams.
• Collaborate with the Legal team to ensure adherence to pricing appeal regulatory requirements.
• Execute claim adjustments and communicate equitable reimbursement outcomes to pharmacy partners.
• Maintain accurate records of appeals and generate reports on pricing trends and discrepancies.
• Develop and manage the claims review process specifically at the NDC level.

Requirements

• Bachelor’s degree.
• 5+ years of experience in reviewing claims or payment appeals in healthcare, pharmacy, or PBM.
• In-depth knowledge of pharmacy operations, drug pricing, and reimbursement workflows.
• Knowledge of state or federal pricing appeal laws.
• Intermediate proficiency with Microsoft Excel, Word, and PowerPoint.
• Ability to work within US time zones and jurisdictions.

Nice to have

• Certification in pharmacy technician or a related field.

Culture & Benefits

• Commitment to a diverse workplace and equal employment opportunities.
• Opportunity to work in a fast-paced environment with a focus on high-impact health tech infrastructure.
• Professional environment emphasizing a "go-get" attitude and independent project tracking.