Geared toward healthcare law professionals comfortable with regulatory compliance and negotiation, based in Kentucky with a preference for those experienced in pharmacy benefits and litigation.
Derived from job-description analysis by Serendipath's career intelligence engine.
Original posting from Machinifyinc via Greenhouse
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.
About the Opportunity
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
Equal Employment Opportunity at Machinify
We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/