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Envision Pharma Group · 1 day ago

Senior Consultant, Payer Rebates

United States

Full-time

Remote

Senior Level

5+ years exp

Envision Pharma Group is a company dedicated to creating life-changing outcomes for clients in the life sciences industry. As a Senior Consultant, you will provide strategic guidance to healthcare organizations on managing relationships with insurance providers and optimizing reimbursement for services, while ensuring regulatory compliance and operational efficiency.

Health CareLife ScienceMedicalPharmaceutical

Hiring Manager

Nicole Gossett

Responsibilities

Manage executed managed care contracts from system entry through to rebate validations and payment using multiple systems in a timely and compliant manner

Ensure accurate and timely processing of assigned accounts including system entry, rebates, validation, reporting, correspondence, and all other aspects of commercial contract administration

Perform detailed analysis and validation of rebate claim data in order to accurately adjudicate the managed care rebates according to the terms specified in the contracts

Perform formulary review on a quarterly basis to confirm formulary position of products on contract

Set up and maintain contracts pertaining to assigned accounts in rebate adjudication system and ensure that they properly reflect the contract terms and requirements

Reviews key financial, membership and utilization report to monitor trends and research any significant changes in utilization

Collaborates with team members across multiple departments to facilitate the exchange of information, address needs, and clarify contract requirements with internal and external customers

Serve as liaison between management and customers in order to resolve any disputed rebate claim data

Qualification

Managed care consultingHealthcare financePayer contractingContract negotiationFinancial analysisBachelor's degreeBusiness AdministrationTechnology related field