Sr Mgr, Managed Care Rebates

Role Summary

The Senior Manager, Managed Care Rebates leads department staff in the processing of Managed Care, Medicare Part D, Managed Medicaid, CMS Rebates, and Medical Rebate claims and fees in accordance with the terms and conditions of rebate contracts and internal processing procedures. This position also maintains and communicates accurate cash forecast information, rebate trends, and impacts to Gross to Net and Government Pricing. The Senior Manager, Managed Care Rebates reports to the Director of Brand and Generic Rebates.

Responsibilities

• Assists staff with contract interpretation, entering contract terms (products, plans, reimbursement percentages, etc.) into Model N/Flex system, rebate calculations and payment requests
• Maintains and updates NCPDP and 340B pharmacy lists in Model N/Flex for claim validation
• Reviews and approves contract terms and rebates in various systems to ensure accuracy and contract compliance
• Works in partnership with Contract Compliance Team to ensure customers adhere to contract parameters; authorizes exclusions when appropriate
• Collaborates with Contract Compliance Team, Market Access Team and customers to track and resolve disputes
• Provides input to Contracts Team and Legal in development of complex contract terms and conditions impacting Claims Administration
• Interprets all legislative actions affecting rebates; Modifies systems and processes to ensure regulatory compliance
• Prior understanding of PBM invoicing to Pharmaceutical Manufacturers to assist Analysts with validations and disputes
• Familiarity with Medical Claim Benefits to assist Analysts with validations and contract reviews
• Experience with Formulary position as they relate to Health Plans to assist in Analyst validations and impact
• Advises branded business units of material rebate variances and gain business unit approval on all exceptions
• Assist in providing operational direction to the Director of Rebates and internal teams on identification of discrepancies and trends
• Establishes and maintains policies, procedures, and standards for rebate processing in support of SOX, internal/external financial reporting, and government contract legislation
• Selects, hires, trains, develops, and retains competent individuals within the team
• Assesses and defines areas of technological advancement, including key trends and metrics
• Responds to all internal and external audit requests

Qualifications

• Bachelor‚Äôs degree with emphasis in Business, Finance, Accounting or related fields or equivalent combination of education, training and/or direct work-related experience
• Minimum of 3 years Pharmaceutical experience; Experience with Managed Care Rebate Processing, Rebates Disputes, Contract Terms
• Strong analytical and data interpretation skills to analyze and resolve complex problems
• Ability to analyze processes and systems to improve efficiency and effectiveness through technology and automation
• Exemplary interpersonal skills; ability to effectively coach staff
• Excellent written and verbal communication; Develop and foster strong relationships with internal and external clients
• Strong organizational skills; Committed to meeting deadlines; prioritizing workload according to organizational needs; demonstrates ability to manage priorities
• Intermediate level Excel, Word, PowerPoint; Model/N Flex experience preferred

Education

• Bachelor‚Äôs degree in Business, Finance, Accounting or related field, or equivalent experience