What are the responsibilities and job description for the Government Pricing position at Denrose Search?
Job Description
Medicaid and Government Pricing
Key contributor within the Commercial Operations Team, with demonstrable knowledge and experience in government pricing calculations and reporting, including Medicaid and Medicare programs.
Maintain the accuracy of calculations within applicable systems. Participate in testing calculation setups and functionality through collaboration with IT.
Calculate and file appropriate prices for the federal drug programs. Prices include BP, AMP, ASP, PHS / 340B, NFAMP, FCP / FSS, IFF, and URA.
Ability to handle complex Government Pricing concepts such as bundles, discount reallocation, pro-ration, and smoothing.
Responsible for maintaining valid customer Class of Trades assignments per regulations.
Expected to continually build detailed subject matter expertise and thought leadership in government program regulations and share this knowledge with direct reports and peer groups.
Prepare backup and documentation for calculations and lead monthly and quarterly meetings on Government Pricing Calculations. Ensure proper sign-off and documentation for the calculations.
Responsible for the Medicaid Drug Rebates Process, which includes, but is not limited to, Medicaid / SPAPs / Supplemental Rebate processing within the time allotted by CMS; reviewing rebate claims for approval and analysis for disputes and dispute resolution; coordinating the timely issuance of checks and outbound packages to the states,
Interface with various state and Federal Government agencies
Ensure compliance with Internal Policies for proper controls and SOX Compliance. In addition, develop and update Business Process Procedures and recommend improvements / changes to company policies and procedures
Perform financial forecasting on how the company's Medicaid rebate liability will be impacted based on pricing decisions (price increase and changes to commercial discounts), as requested.
Collaborate with cross-functional teams to ensure that accruals are correctly booked, manage financial models to forecast, produce trend analysis, and assist in reporting accurate GTN results.
Model "what if" scenarios and present findings to stakeholders based on potential pricing strategy, current pricing, and current and / or upcoming government programs and legislation.
Chargeback
Responsible for supervision and oversight of Chargeback Processing, which may include :
Ensures accurate and timely chargeback data are entered into contract systems consistent with agreement terms, corporate controls, and Sarbanes-Oxley regulations.
Ensure all inbound chargeback request transmissions and resubmissions (e.g., EDI 844 and other electronic and hardcopy formats) from wholesalers are received and loaded into the chargeback system on a timely basis for processing and validation
Ensure outbound chargeback reconciliation reports (including EDI 849 and other electronic and hardcopy formats) are provided to wholesalers on a timely basis
Train and provide guidance and support to Chargeback Analysts
Responsible for the validation, implementation, and maintenance of membership and pricing associated with government group customer contracts, which include, but are not limited to, Public Health / Disproportionate Share Hospitals, VA / DoD, and Federal Supply Schedule within the Contract Management System
Responsible for ensuring the Chargeback Management System is working correctly and is configured to the needs of the organization
Development and Reporting of Metrics against benchmarks to ensure proper excellent service is being provided to Customers
Assistance as needed in dispute resolution with Customers, which may include Customer Audits
Ensure compliance with Internal Policies for proper controls and SOX Compliance. In addition, develop and update Business Process Procedures and recommend improvements / changes to company policies and procedures.
Qualifications And Education Requirements
Bachelor's degree required
A minimum of seven (7) years of experience in the Pharmaceutical Industry working with state and federal pricing, reporting, and rebate programs is required.
Experience working in mandated deadline environment, effective in managing multiple stakeholder assignments, ability to prioritize
Demonstrable knowledge of the current policies and guidelines that affect government programs, pricing, and payment adjustments (e.g., Final Rule, Proposed Rule, Inflationary Reduction Act).
Knowledge and experience with Medicaid Drug Rebate Program, regulations, guidelines, and current updates
Knowledge of Medicaid systems to ensure appropriate data collection and rebate processing / payments
Understanding of wholesaler sales, membership, and Bid contracts preferred
Working knowledge of Third-party data sources for DEA#, HIN#, and PHS and FSS websites preferred
Track record of self-development. Contributions to the function's overall success and depth of knowledge.
Preferred Skills
Proficiency in MS Office tools
Possess strong problem-solving, communication, and analytical skills
Familiarity with enterprise-wide integrated application systems
System knowledge of SAP is a plus
Knowledge of the pharmaceutical industry is required.
Detail-oriented with a high degree of accuracy.
Strong analytical, verbal, and written communication skills are required.
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