Analyst, Managed Care Rebate Operations

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Summary:

This role is responsible for contract administration, data validation, analysis, processing and payment of rebates associated with Managed Care contracts. Primary duties include 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.

Responsibilities:

* Review executed paper contract, develop summary of contract terms and set up contract to accurately reflect the intent of the contract.

* Maintain Managed Care rebate contracts including contract terms, membership and formulary status

* Review and validate submitted Managed Care rebate claims data and make decisions on claims eligibility based on plan formulary status and compliance. Calculate rebates on eligible claims, review for accuracy through the thorough analysis and resolution of discrepancies and make decision on final payment due to customer per contract terms.

* Collaborate with Contract Operations team, as needed, to ensure that the intent of the contract is carried out in the rebate calculations and payments.

* Provide analytical thinking and business acumen to identify and make decisions to resolve variances in claims data trends or expected rebate rates. Evaluate invoices for year-to-date rebate payment trends and provide explanations for variances vs. prior periods. Make decisions to escalate certain unexplained variances which may indicate potential compliance or performance issues to leadership for further action.

* Prepare payment packages and process payments. Resolve outstanding issues to ensure payments are made within the contractual timeframe.

* Monitor drug formulary compliance.

* Serve as primary contact with external customers (payers) and Contract Operations team to address questions or to resolve issues. In the event of disputes, gather supporting facts and make recommendations for resolution for approval by management.

* Apply process oriented and critical thinking to enhance organizational effectiveness of accurate and timely contract administration and rebate processing. Revise SOPs as required to reflect process improvements.

* Maintain compliance with SOX and audit controls governing contract and rebate operations.

* Assist in fulfilling requirements related to internal/external audits of systems and processes, legal requests and government agency inquiries.

Qualifications:

* Minimum 2 years of experience in one of the following: contract administration, rebate processing or business/financial analysis

* Experience with analytical techniques to determine reasonableness of data, trends and the root cause of issues

* Demonstrated strong organizational skills

* Proven ability to multitask and make rapid decisions when discrepancies or non-routine situations arise

* Acquired effective communication skills and has dealt with both internal and external customers while obtaining the know-how to prompt them for complete/accurate information

* Flexible, team player open to collaborating across team assignments and ad-hoc projects

* MS Office (Excel, Access)

* Managed Care experience is preferred

* BA/BS degree is preferred

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