Pharmacy Benefit Coder Jobs (NOW HIRING)

About Us

As a rapidly growing organization, Innovative Rx Strategies is distinguished by its commitment to advocating for clients both personally and financially while delivering measurable cost savings for employers and their employees.

Are you interested in joining a successfully growing organization that has been recognized for over a decade as a Best Place to Work, recipient of Healthiest Workplace awards, and The Platinum Bell Seal for Workplace Mental Health? If so, come join our Innovative Rx Strategies team of clinical experts!  

Our team serves employers, benefits brokers, TPAs, health care systems and health plans with deep understanding of the pharmacy benefits markets and health care industry trends. With expert knowledge we are committed to one mission — breaking down a complex industry to save our clients' money on their benefits programs and manage their cost trends.

Innovative Rx Strategies is an Apex Benefits Group, Inc. (ABG) company. ABG offers competitive benefits, flexible hybrid/remote work model, a collaborative team environment, and advanced training and development. 

Job summary

The Clinical Account Director develops and executes the strategy to provide overall day-to-day clinical consulting and account management to ensure the effective execution of client objectives and the PBM contract.   This role is ideal for a strategic, client-focused professional with deep expertise in pharmacy benefits and healthcare consulting. The position blends account management, data analysis, vendor oversight, and clinical advisory services to deliver high-impact solutions for employer-sponsored health plans. You’ll lead client engagements, interpret complex benefit designs, monitor pharmacy performance, and guide decision-making around high-cost drugs and formulary strategy. With responsibilities spanning compliance, channel strategy, and PBM coordination, this role offers a dynamic opportunity to shape pharmacy benefit outcomes across diverse employers.  

The starting salary for this position begins at $135,000. Final compensation will be determined based on experience, qualifications, internal equity, and market considerations.

Summary of essential job functions/responsibilities

 Account Management

• Coordinate meetings, agendas, and follow-up action items related to pharmacy benefit activities
• Deliver exceptional customer service, including interpreting plan designs, resolving claims and member issues, and addressing benefit and enrollment inquiries
• Conduct routine onsite account visits as needed
• Monitor compliance and legislative changes, advising clients and ensuring adherence to regulatory requirements

 Data Management

• Lead data assessments, trend analysis, and reporting for clients
• Present routine trend reports and annual performance reviews
• Plan and execute annual reconciliation and market check processes
• Collaborate with clinical and analytics teams to monitor pharmacy claims performance, identifying opportunities to enhance benefits, close clinical gaps, and drive cost savings

 Vendor Management

• Ensure vendors meet client-specific needs and timelines
• Interface with PBM operations to resolve issues efficiently
• Support implementation of new PBMs, programs, and services
• Provide clinical insight during vendor evaluations and the selection of pharmacy benefit managers and consulting solutions

Clinical & Advisory Services

• Make informed decisions considering 340B status and pricing implications
• Manage custom client-facing formularies
• Support Pharmacy & Therapeutics (P&T) initiatives focused on employer benefits
• Navigate the financial complexities of owned-entity pharmacies
• Advise clients on new-to-market and high-cost drugs, including cost-saving strategies for A/C/J/Q codes and other medical benefit medications

Minimum requirements

• Pharmacy degree required; PharmD or Pharmacy Residency preferred
• A minimum of 5 years of practical pharmacy experience required or equivalent with a managed care pharmacy residency; previous PBM or Pharmacy Benefit experience preferred.
• Knowledge of current business and industry trends
• Superior problem solving, analytical ability, attention to detail and customer service skills
• Positive attitude, willingness to learn and interest in working towards team goals
• Relationship builder
• Excellent organizational and time management skills
• Highly developed reasoning and problem-solving skills
• Strong verbal communication skills, with ability to present in person with clients and prospects
• Self-motivated, with ability to meet deadlines; ability to work productively and proactively
• Ability to plan, organize, and work on multiple tasks simultaneously and exercise independent judgement
• Proficient in Excel, Word, PowerPoint, and other analytic tools that may be introduced
• Abide by all obligations under HIPAA related to Protected Health Information (PHI) and Capable of maintaining confidential information

Additional Information

Apex Benefits Group, Inc believes in equal opportunity employment and does not discriminate based on age, race, color, religion, gender, sexual orientation, gender identity, gender expression, national origin, protected veteran status, disability, or any other legally protected status.

Innovative Rx Strategies is an Apex Benefits Group, Inc. (ABG) company. ABG offers competitive benefits, flexible hybrid work model, paid time off, a collaborative team environment, and advanced training and development.

This is a remote position with travel requirements. Must be able to travel for meetings, training, conferences, and/or client visits approximately 6–10 times annually, including occasional overnight stays.

This role is U.S.-based and operates primarily within Eastern Time Zone. We have a preference in states where we currently employ team members, including Indiana, Ohio, Illinois, Kentucky, Texas, North Carolina, Tennessee, and Pennsylvania.