Sumitomo Pharma America, Inc. · 16 hours ago
Analyst, Medicaid Rebates
United States
Full-time
Remote
Mid Level
$70K/yr - $88K/yr
3+ years exp
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Responsibilities
Process Medicaid State, MCO & SPAP rebate payments using the Model N software or similar application. Enter/upload all invoice information, review trending against prior periods, prepare payment packages, coordinate approval process, provide backup documentation and follow up with A/P to ensure all payments are completed on time
Maintain the Model N or similar Medicaid system- calculate Medicaid Unit Rebate Amounts (URA’s), update contracts, CPIU and T-Bill updates, participate in UAT of system upgrades and service patches
Request and review claim level detail (CLD) to confirm validity of rebate invoices. Work with large amounts of data and be able to analyze for anomalies, outliers, patterns, and trends
Uploads CLD into Commercial Validata module to scrub for duplicate claims across channels
Initiate disputes with states when warranted
Communicate unusual invoicing activity to management and internal stakeholders
Investigate, analyze information, and resolve business questions and disputes by applying information from various data sources, business rules and system processes
Understand the specific differences in Medicaid invoicing and CLD state by state and able to recommend and adjust processes to accommodate differences
Foster and maintain constructive working relationships with State contacts and invoice intermediaries while resolving business issues with invoicing and data inaccuracies. Communicate and resolve discrepancies in these situations with minimal supervision while maintaining positive relationships and professionalism
Maintain service standards in processing data and proactively advise management of issues
Maintain status reports and update numerical information in spreadsheets
Adhere to SOP’s, Work Instructions, and SOX control documents as they relate to department business processes and update documents as needed
Identify and recommend improvements in business procedures and outcomes
Perform other responsibilities as assigned
Qualification
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Required
Minimum education required: HS Diploma.
Three years general business experience or two years specific experience in a pharmaceutical company environment.
Knowledge of and experience with common industry software programs (i.e. CARS/IS Classic and Revitas Flex, Model N or other similar industry standard software).
Must have keen attention to detail and ability to conduct repetitive transactions and processes using computer systems.
Must have fundamental knowledge of pharmaceutical product contract agreements.
Must have proficiency in working with Microsoft Office products (Excel, Word, Outlook).
Able to investigate, analyze information and resolve business questions by applying information from various data sources, business rules and system processes.
Solid knowledge of pharmaceutical product contract agreements and the Medicaid Regulatory environment.
Excellent organizational and communication skills (verbal and written).
Preferred
Bachelor’s or associate degree.
Benefits
Merit-based salary increases
Short incentive plan participation
Eligibility for our 401(k) plan
Medical, dental, vision, life and disability insurances
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
Company
Sumitomo Pharma America, Inc.
Sumitomo Pharma America (SMPA) is a science-based, technology-driven biopharmaceutical company focused on delivering therapeutic and scientific breakthroughs in areas of critical patient need in oncology, urology, women’s health, rare disease, cell and gene therapies and psychiatry and neurology.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Adele Gulfo
Chief Executive Officer, Biopharma Commercial
Myrtle Potter
President and Chief Executive Officer, Sumitomo Pharma America
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