The opportunity
The Managed Care Rebate Analyst is responsible for the processing of Managed Care Commercial, Medicare Part D, Managed Medicaid, and Medical Agreement rebate claims in accordance with the terms and conditions of the rebate contract and internal processing procedures. This position is responsible for analyzing utilization data, applying rules to determine included and excluded claims, assigning appropriate rebate percentages to utilization sales, and initiating payment to customers within contractual guidelines.
The Managed Care Rebate Analyst must interpret contract language and input and maintain plans, products, and rebate programs in the Model N/Flex System; this position must have a thorough understanding of PBM networks and contractual verbiage as stated in assigned account agreements
Aids in the delivery of key information in support of rebate forecasting, contract performance assessment, and financial and government reporting using the Model N/Flex system
Provides first level approval, as required by SOX, of all outbound rebate claim documents for accuracy (dollars and coding) and completeness
Analyzes and resolves disputes with accounts involving contract interpretation or processing issues; engages Managed Market team or other internal teams as needed
Tracks and communicates rebate trending, invoice to payment variances, and prior period analysis
Recommends improvements to and provides assistance in the modification of systems and processes including User Acceptance and Regression Testing
Helps in the exercise of rebate forecasting by providing timely information regarding account current account dynamics
Your experience and qualifications
Education/Certification/Experience:
Bachelor’s degree required.
Minimum of 1 year but preferred 2 years of pharmaceutical operational experience, preferably with reimbursements (Purchased based or managed care rebates, Medicaid rebates, Chargebacks).
Strong proficiency in Microsoft Excel (advanced functions such as pivot tables, v-lookups, etc.).
