Sr. Manager, Medicaid Contract Administration

6 months ago

Marlborough, United Kingdom Sumitomo Pharma America, Inc Full time

Title: Sr. Manager, Medicaid Contract Administration

Location: Remote/occasional onsite (if local to MA). Flexible work/life balance.

Sumitomo Pharma America (SMPA) is focused on delivering therapeutic and scientific breakthroughs in areas of critical patient need spanning psychiatry & neurology, oncology, urology, women’s health, rare disease, and cell & gene therapies. The company’s diverse portfolio includes several marketed products and a robust pipeline of early- to late-stage assets. Building on Sumitomo Pharma’s 125-year legacy of innovation, SMPA leverages proprietary in-house technology platforms and advanced analytics capabilities to accelerate discovery, development, and help bring novel therapies to patients sooner. SMPA is a Sumitomo Pharma company. [For more information, visit ]

Job Overview

We are currently seeking a dynamic, highly motivated, and experienced individual for the position of Sr. Manager, Medicaid Contract Administration. The Sr. Manager, Medicaid Contract Administration is responsible for managing the Medicaid rebate team in receiving, processing, validating, trouble-shooting Medicaid claims and dispute resolution with state agencies. This position requires a detailed understanding of the life science industry specific to the Medicaid payer landscape. The decisions made in this position affect company sales, pricing discounts, and best price implications. This role also facilitates working relationships with both internal and external customers. This is a hybrid role with 2-3 days a week required in office.

Job Duties and 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. Able to 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. Identifies and resolves discrepancies in submitted data invoices to ensure legitimacy of contract discounts. Ensures detailed accuracy of correct data input into company systems. Maintains service standards in processing data submitted by customers and proactively advises 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. Performs other responsibilities as assigned.

Key Core Competencies

Six plus years’ experience in the healthcare/pharmaceutical industry. Knowledge and experience in common industry software programs (i.e., Model N). Has experience in processing Medicaid rebates preferably using Model N software application or other similar industry standard software. Able to investigate, analyze information, and resolve business questions by applying information from various data sources, business rules and system processes. 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.

Education and Experience

Minimum 8 – 12 (w/o Master’s) or 6 – 8 years (with Master’s) years of relevant experience in biotech or pharmaceutical industry.

The base salary range for this role is $128,800 to $161,000. Base salary is part of our total rewards package which also includes the opportunity for 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. Our robust time-off policy includes unlimited paid time off, 11 paid holidays plus additional time off for a shut-down period during the last week of December, 80 hours of paid sick time upon hire and each year thereafter. Total compensation, including base salary to be offered, will depend on elements unique to each candidate, including candidate experience, skills, education and other factors permitted by law.

Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.

Confidential Data : All information (written, verbal, electronic, etc.) that an employee encounters is considered confidential.

Compliance :Achieve and maintain Compliance with all applicable regulatory, legal and operational rules and procedures, by ensuring that all plans and activities for and on behalf of Sumitomo Pharma America (SMPA) and affiliates are carried out with the "best" industry practices and the highest ethical standards.

Mental/Physical Requirements : Fast paced environment handling multiple demands. Must be able to exercise appropriate judgment as necessary. Requires a high level of initiative and independence. Excellent written and oral communication skills required. Requires ability to use a personal computer for extended periods of time.

Sumitomo Pharma America (SMPA) is an Equal Employment Opportunity (EEO) and Affirmative Action employer

Sumitomo Pharma America (SMPA) is committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race; color; creed; religion; national origin; age; ancestry; nationality; marital, domestic partnership or civil union status; sex, gender, gender identity or expression; affectional or sexual orientation; disability; veteran or military status or liability for military status; domestic violence victim status; atypical cellular or blood trait; genetic information (including the refusal to submit to genetic testing) or any other characteristic protected by law.

For more information about EEO and the Law, please visit the following pages:

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