Manager Rebate Operations

Manager, Contract & Rebate Operations handles all aspects of contract administration, validates rebate claims, and calculates payments for managed care, government, or pharmacy benefit managers (PBMs). The manager ensures accurate contract execution, disputes discrepancies with external payers, and maintains compliance with regulatory standards. This position requires expertise on the validation, analysis and payment of rebates related to Managed Care Organizations (MCO) and Group Purchasing Organization (GPO) contracting and strong knowledge of Government Pricing for Federal Supply Schedule/Public Health Solutions (FSS/PHS) Contracting.

• Review, analyze, and enter complex contract terms in the system for managed care and commercial payers.
• Ensure rebate terms are reflected accurately in the system to ensure proper payments.
• Review, validate, and process submitted rebate claims data for accuracy, ensuring compliance with contract terms, including the following:
  • Interpretation and evaluation of contract terms, claims eligibility validation, formulary verification, rebate adjudication and external customer management to ensure proper determination and payment of contracted rebates.
  • Review and validate submitted Managed Care rebate claims data and make decisions on claims eligibility based on plan formulary status and compliance. Escalate to the Director of Contract & Rebate Operations as needed for approvals.
  • Calculate rebates on eligible claims, review for accuracy through the thorough analysis and resolution of discrepancies, and make recommendation on final payment due to customer per the contract terms prior to submitting to the Director, Contract & Rebate Operations for approval.
  • Make decisions to elevate certain unexplained variances which may indicate potential compliance or performance issues to the Director, Contract & Rebate Operations and Market Access team for further action if necessary.
  • Prepare payment packages and process payments.
  • Monitor Payer agreements for price protection. Validate price protection clauses in each payer agreement ensuring that formulas are accurate and analyze final output to ensure that accurate price protection rebate amounts are calculated.
  • Act as the primary contact with external customers (payers) to address questions and resolve discrepancies in claims data. In the event of disputes, gather supporting facts and make recommendations for resolution.
  • Set up/maintain contract membership as per eligibility requirements.
  • Perform detailed Formulary verification for rebate eligibility. Maintain strong understanding of Pharmacy Benefit Managers/MBM formulary structures, coverage criteria, benefit design changes, and how they impact rebate qualification Research and continue to monitor drug formulary compliance. Raise issues to Market Access team if changes in formulary position occur.
  • Monitors/reports on rejections/reversals and formulary status to Account Management as necessary.
• Assist with Canada rebate research, data confirmation and processing of payments.
• Assist with the validation and processing of Medicaid invoices from States for multiple programs per state within a 38‑day processing period.
• May assist with daily wholesaler chargebacks.
• May collaborate with cross‑functional teams such as Market Access, Legal and Finance.
• Perform miscellaneous ad hoc projects and analysis as needed.
• Perform reporting both for internal and external departments based on requests and reporting needs using tools such as Model N and Microsoft Excel.

• A Bachelor’s degree in Business, Finance, Accounting or related field is preferred.
• Prior experience in pharmaceuticals or healthcare related industry is preferred.
• A minimum of 5 – 6 years’ experience in MCO/GPO Contracting and/or Medicaid related fields.
• Strong knowledge of Government Pricing for Federal Supply Schedule/Public Health Solutions (FSS/PHS) Contracting.
• Prior experience in Medicaid, Finance, Rebate Management and Contract Administration.
• Knowledge of Pharmaceutical Managed Care Market; contracting processes including Medicaid Rebates.
• Prior experience with Model N Full suite…