Medicaid Contract Administration Manager
7 days ago
Job Overview
We are seeking a highly motivated and experienced individual for the position of Medicaid Contract Administration Manager. The successful candidate will be responsible for managing the Medicaid rebate team, receiving, processing, and validating Medicaid claims, and resolving disputes with state agencies.
Key Responsibilities
- Lead operations person for all Medicaid decisions as it relates to Model N implementation and payment process.
- Lead subject matter expert (SME) for shared service model.
- Experience in processing Medicaid rebates preferably using Model N software application or other similar industry standard software.
- Investigate, analyze information, and resolve business questions by applying information from various data sources, business rules, and system processes.
- Ability to understand and perform complex rebate and best price calculations.
- Foster and maintain constructive working relationships with customers while resolving business issues dealing with data correctness.
- Interact with internal departments (Internal Audit, Commercial Insights, Contracting, SOX Compliance, and Legal) to clarify policy compliance requirements and contract language clauses.
- Keep current on regulatory and industry changes that may impact Medicaid operations.
- Oversee the Medicaid Dispute Resolution process.
- Keen attention to detail and ability to conduct repetitive transactions and processes using computer systems.
- Identify and resolve discrepancies in submitted data invoices to ensure legitimacy of contract discounts.
- Ensure detailed accuracy of correct data input into company systems.
- Maintain service standards in processing data submitted by customers and proactively advise management of issues.
- Able to identify and recommend improvements in business procedures and outcomes.
- Create and maintain ongoing SOP documentation for department processes and confirm adherence to final policies and system requirements.
- Train staff on Medicaid landscape and Model N system navigation.
- Manage a staff with a concentration on career development.
Requirements
- Minimum 8 – 12 (w/o Master's) or 6 – 8 years (with Master's) years of relevant experience in biotech or pharmaceutical industry.
- Knowledge and experience in common industry software programs (i.e., Model N).
- Proficient in MS Office (Word, Excel, Access, PowerPoint, MS Project, Visio, SharePoint).
- Customer-focused ability to communicate across all levels of the organization.
- Excellent written skills required.
- Strong problem-solving, critical thinking, communication, and sound judgment skills.
- Solid experience in supporting System/application jobs and troubleshooting production issues in complex software solutions.
- Fast-paced environment handling multiple demands.
- Must be able to exercise appropriate judgment as necessary.
- Requires a high level of initiative and independence.
- Strong attention to detail required.
- High degree of organizational awareness, ability to connect the dots to understand all the interdependency and big picture.
About Sumitomo Pharma America, Inc.
Sumitomo Pharma America, Inc. is a leading pharmaceutical company focused on delivering therapeutic and scientific breakthroughs in areas of critical patient need. We are committed to a culturally diverse workforce and offer a comprehensive benefits package, including competitive salary, merit-based salary increases, short incentive plan participation, eligibility for our 401(k) plan, medical, dental, vision, life, and disability insurances, and leaves provided in line with your work state.
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