As part of the Pharmacy team, you will provide legal counsel and support for the Coordination of Benefits (COB) Pharmacy operations. This role ensures compliance with federal and state laws, contractual obligations, and regulatory requirements related to pharmacy benefits coordination. The attorney will collaborate with internal teams, external partners, and regulatory agencies to mitigate risk and support business objectives. Familiarity with litigation practice, mediation and settlement negotiations is a plus.
What you'll do - Identify relevant legal issues that could impact Pharmacy Operations and advise business leaders as appropriate so that informed decisions can be made.
- Provide timely and appropriate legal review and advice for the Pharmacy Operations team. This will include communicating with parties outside of Machinify to assist in the recovery efforts of the analysts.
- Monitor and interpret applicable laws, regulations, and guidance from CMS, state insurance departments, and other governing bodies.
- Identify potential legal risks and develop strategies to mitigate exposure in Pharmacy operations.
- Provide legal training to Pharmacy staff on compliance obligations and emerging regulatory trends.
- with PBM representatives and employer group benefit managers to Negotiate resolve contested Pharmacy recoveries.
- Manage and oversee litigation or disputes related to Pharmacy, including coordination with outside counsel when necessary.
- Assist Client Success with legal opinions and interpretations to respond and resolve client inquiries -may include participation in client or group conference calls.
- Communicate as needed to Pharmacy Operations regarding new court decisions, statutes, and regulations with instruction as to the effects on file handling.
- Work closely with compliance, operations, and pharmacy benefit management teams to ensure seamless integration of legal considerations into business processes
- Present at industry and legal conferences to promote industry understanding of Pharmacy service offerings.
What experience you bring (Role Requirements) - Juris Doctor (JD) from an accredited law school; active license to practice law in the state of Kentucky as a member in good standing.
- Minimum 3-5 years of legal experience, preferably in healthcare, pharmacy benefits, or insurance law.
- Familiarity with COB processes, pharmacy benefit management, and healthcare regulations (HIPAA, ERISA, CMS guidelines).
- Strong analytical and problem-solving abilities.
- Excellent written and verbal communication skills. Ability to communicate effectively throughout all levels of the organization.
- Willingness to handle disputed settlement negotiations and participate in litigation.
- Ability to manage multiple priorities in a fast-paced environment.
- Collaborative mindset with attention to detail.
- Working knowledge with Microsoft Office products.
Pay range: $110,000 - $135,000 USD. The salary range is for Base Salary. Compensation will be determined based on several factors including, but not limited to, skill set, years of experience, and the employee's geographic location.
What's in it for you- PTO, Paid Holidays, and Volunteer Days
- Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts
- Tuition Reimbursement
- Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.
- Remote and hybrid work options
What values we'll share with you - Ask why
- Think big
- Be humble
- Optimize for customer impact
- Deliver results
