Teva Pharmaceuticals Parsippany, NJ
Company Info
Teva is a global pharmaceutical leader and the world’s largest generic medicines producer, committed to improving health and increasing access to quality health solutions worldwide. Our employees are at the core of our success, with colleagues in over 80 countries delivering the world’s largest medicine cabinet to 200 million people every day. We offer a uniquely diverse portfolio of products and solutions for patients and we’ve built a promising pipeline centered around our core therapeutic areas. We are continually developing patient-centric solutions and significantly growing both our generic and specialty medicines business through investment in research and development, marketing, business development and innovation. This is how we improve health and enable people to live better, healthier lives. Join us on our journey of growth!
Job Description
The Manager of Medicaid Claims & Contract Administration will manage operations to provide prompt, accurate and compliant processing/payment of Medicaid rebates to our customers. Ensure that each assigned customer rebate program adheres to all CMS and other applicable requirements. This position also ensures that State federal and supplemental rebate programs are actively monitored. Ensure training for internal Medicaid analysts are accomplished, and the accurate publishing of documentation of communications addressing any changes in guidance for the Medicaid program that will impact to other internal operations. This position is responsible to provide first level approval, as required by SOX, of all outbound claim documents for accuracy (dollars & coding) and completeness. This position also provides key role in supporting of rebate/cash forecasting, government reporting, process improvement, system upgrade/implementation and ad hoc analysis and reports.The Manager, Medicaid Claims & Contract Administration reports to Director of Medicaid. This position is a Shared Service position and provides support for all Teva products.
- Review and approve high volume claims to ensure accuracy and completeness;Minimize revenue leakage and reduce interest in a tight timeframe.
- Provide guidance to staff in resolution of disputes with states. Escalate material unresolved issues to Director or Sr. Manager
- Setup new programs / contracts and perform system maintenance in Model N/Flex systems. Validate & approve contract updates for federal, state & supplemental rebate programs. Provide insights concerning state, program and product trends. Handle Terms/Conditions for Supplemental
Enter all Contract pricing into worksheets to ensure data is updated timely
Work with Sr. Mgr. to activate and validate rebate calculations.
Work closely with Contracting Team to confirm supplemental agreements in place and ensure all programs entitled to rebates are accurate - Assist in performing quarterly pricing activities to include updates and entries in Medicaid Processing systems for all Customers.
- Work independently with Finance on dispute report totals. Handles dispute report directly with Finance.
- Stay on top of CMS Medicaid rule changes. Establish and maintain policies, procedures, and standards for Medicaid Rebate Processing in support of SOX, internal/external financial reporting, and government regulations. Manage Audit – handle PwC Medicaid Audits for all quarterly requests timely
Pull all required State Invoices, ROSI/PQA, check/ACH and PAT approvals
Address any questions or issues w/Sr. Mgr. on data selections from claims
Work closely with Finance to ensure all data submitted is complete and accurate
Scan, save and send all audit requested information - Hire, coach, mentor, train and retain a high performing staff.
Qualifications
Requirements:
- Bachelor’s Degree Required
- Minimum of 5 years of Medicaid Claim processing experience with Pharmaceutical company , state and/or state agency or as Medicaid consultants
- Must have Intermediate to advanced knowledge of the Model N or Revitas/Flex Medicaid and/or Flex Validata system (or other comparable system) and advance Microsoft Excel skills.
- Familiar with CMS Medicaid rules and state specific issues.
- Up to date knowledge on Medicaid Validation rules and issues with 340B covered entities.
- SAP, Business Intelligence, and Tableau reporting preferred.
- Strong ability to multi-task, organize and manipulate large volume of data in various formats.
Preferred:
- MS or MBA
- Pharmaceutical Industry experience; Medicaid Claim processing function; manipulation of large datasets, negotiation/conflict resolution.
- System Implementation and report writing.
- Medicaid, Government Pricing and Rebate Pharmaceutical industry experience/knowledge prefer.
Function
Marketing
Sub Function
Managed Care Administration
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Teva’s Equal Employment Opportunity Commitment
Teva Pharmaceuticals is committed to equal opportunity in employment. It is Teva’s global policy that equal employment opportunity be provided without regard to age, race, creed, color, religion, sex, disability, pregnancy, medical condition, sexual orientation, gender identity or expression, ancestry, veteran status, national or ethnic origin or any other legally recognized status entitled to protection under applicable laws.We are committed to a diverse and inclusive workplace for all. If you are contacted for a job opportunity, please advise us of any accommodations needed to support you throughout the recruitment and selection process. All accommodation information provided will be treated as confidential and used only for the purpose of providing an accessible candidate experience.