The opportunity
The purpose of the position is to identify and resolve compliance and eligibility issues with contracted managed care customers. This position works with the Teva Market Access account managers and the contracted account to gain alignment on formulary product placement and compliance and to recover previously paid rebate or discounts in the event of noncompliant formulary findings.
Reporting to the Manager, Contract Compliance, the incumbent will be responsible for identifying and investigating formulary positions on PBM and Health Plan websites and formal Pharmacy Drug Lists (PDL) to validate product placement complies with all terms and conditions of the managed care contract. Using critical thinking skills and data analytics, the incumbent will complete complex investigational audit reviews, identify risks and compliance issues and present findings both verbally and in writing to key internal and external stakeholders. In addition, the Sr. Contract Compliance Analyst will participate in identifying and recommending contracting strategy changes as it relates to the effectiveness of the contract terms and conditions.
How you’ll spend your day
• Establishes audit plan to review top 80% of contracted account formularies across commercial, Medicare Part D, and managed Medicaid channels.
• Reviews Teva products on each formulary and assesses compliance within stated terms and conditions of contract. Requests and obtains supporting documentation (prior authorizations, step edits, etc.) as need to complete assessment.
