Job Openings Pharmacy Payment Policy Lead

About the job Pharmacy Payment Policy Lead

Pharmacy Payment Policy Lead, Remote

  • Full-time
  • 100% Remote 
  • Must be eligible to work in the US without requiring sponsorship.  


Experienced leader with expertise in Medicare payment policy and operations, pharmacy services, and health plan audits/compliance. 


  • Lead and grow a diverse team with the responsibility to perform advanced analyses and studies of Medicare Part D claims and administrative data. 
  • Advise clients in their efforts to identify and assess improper payments in the Medicare program, by providing pharmacy and Medicare Part D subject matter expertise. 
  • Leverage client specific knowledge and network to lead, plan, and manage progressively larger and more complex programs. 
  • Provide program oversight contributing to project expansion, managing measurement approaches, and synergizing related programs.


Basic Qualifications:

  • 10+ years of experience in a managerial role overseeing projects and diverse teams of technical experts
  • 10+ years of experience specific to Medicare Part D payment policy and operations and error measurement
  • Experience with health plan audit/compliance programs
  • Working knowledge of Medicare Advantage encounter data or Prescription Drug Event (PDE) data
  • Ability to obtain and maintain a Public Trust or Suitability/Fitness determination based on client requirements
  • Certified Pharmacy Technician (CPhT) or degree in a related field; 10+ years of experience in a relevant professional work environment in lieu of a degree

Additional Qualifications:

  • Experience with delivering technical assistance to a wide range of stakeholders and using a variety of delivery techniques
  • Experience in facilitating large meetings with both internal and external audiences
  • Experience with the federal procurement and proposal process
  • Demonstration of existing relationships, as well as the ability to build new key relationships with programmatic/agency leaders in the Centers for Medicare and Medicaid Services
  • Experience with Medicare claims and/or pharmacy claims (e.g.,1500 claim forms, Part D NCPDP claims, UB-04, NCPDP claims, etc.)
  • Basic knowledge of statistical principles
  • Basic knowledge of analytic scripting, programming languages, and packages
  • PharmD or Ph.D. in Pharmacy or related field

Please Note:

  • Only those individuals selected for an interview will be contacted.
  • No calls, inquiries, or Third-Party Vendors please.
  • We are an equal opportunity employer. We encourage applications from candidates of all backgrounds and experiences. (The ACI Group is unable to sponsor H1B Visas).
  • $1000 Referral Bonus -

Since 1988, The ACI Group, a Baltimore-based staffing firm, has been committed to hiring the industry's leading professionals, and presenting exciting career opportunities. We have access to varied types of contract, permanent and contract-to-perm positions and offer a choice of employment options including a full benefits package.