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Rebate Operations Senior Manager

Semma Therapeutics

Semma Therapeutics

Boston, MA, USA
Posted on Saturday, August 5, 2023

Job Description

Job Description

Vertex Pharmaceuticals Incorporated is seeking a Rebate Operations Senior Manager, reporting up to the Director of Price Reporting and Rebate Operations within the US Market Access department, a rapidly expanding function that includes Government Pricing (GP), Rebate Operations, Reimbursement Policy Analytics and State Transparency Reporting.

The Senior Manager position within the department plays a critical role in our team. A successful candidate will administer contractual obligations under the US Medicaid Drug Rebate Program (MDRP), as well as Canadian Rebate Programs, and the associated analytics and reporting obligations. As a member of the Rebate Operations team, you will support data validation activities, administration of rebate operations, provide accurate and compliant processing of payments of US, and Canadian Commercial and Government rebates to our customers, and ensure that payments adhere to all applicable requirements. This position will also lead strategic initiatives, including reporting program payment leakage identification, mitigation and dispute resolution. A strong candidate will have a robust understanding of data integration, and ability to communicate critical information for enhancements and maintenance of rebate systems and management reporting.

Key Responsibilities:

  • Process claims to ensure accuracy and completeness of rebate payments; minimize revenue leakage and interest on late payments in a timely manner through collaboration with Accounts Payable and Treasury.
  • Negotiates effectively with external parties, including government agencies on rebate and contractual obligations and/or disputes.
  • Provides quarterly updates of rebate trends and variance analyses and maintenance of KPIs.
  • Leads set-up and maintain programs/contracts within applicable systems and applications.
  • Validate contract updates for federal, state, and supplemental rebate programs. Testing of program set-ups and expected functionality with IT business partners.
  • Enhances processes and systems for increased efficiency and identification of potential sources of rebate payment leakage. Assist in verification and dispute resolution through good faith inquiry to Covered Entities and State Agencies. Leads tracking and management reporting of identified disputes in resolution on a timely and regular basis.
  • Works collaboratively with cross-functional business partners on forecast and accrual estimates, reporting, and dispute resolutions and analysis.
  • Leads Rebate Operations special projects. Works closely with Data Technology Engineering Teams (IT and/or external vendor) to build the infrastructure and tools to support rebate dashboards and analytical models, including Robotic Process Automation (RPA) tools.
  • Leads optimization and communication of analytics and data for reporting and analysis of customer rebate trending and insights.
  • Establishes and maintains policies, procedures, and standards in support of Sarbanes-Oxley (SOX) requirements, internal/external financial reporting processes, and government regulations and stays abreast of CMS Medicaid rules and guidance changes.

Minimum Requirements:

  • Bachelor’s degree in Business, Finance, Accounting or Public Policy, or equivalent working experience.
  • 6-8 years of experience in Medicaid or Rebate Claim processing with a pharmaceutical company and/or state agency or as a Life Sciences Management Consultant, or equivalent combination of education and experience.
  • Experience with effective management of large datasets, managing peak cycle workloads and contract administration activities.
  • Intermediate knowledge of Model N or Revitas/Flex Medicaid, Revenue Management Suite or Flex Validata systems (or comparable contract and payment system) and data query tools, such as SQL, Alteryx or advanced Excel skills etc..
  • Familiarity with relevant federal and state agencies, CMS Medicaid and 340B statutes and program operations, state specific issues and VA Health Care Act.

Preferred Skills:

  • An entrepreneurial spirit and ability to proactively develop creative solutions to complex problems
  • Ability to communicate confidently and succinctly to cross-functional business partners and team leadership
  • Diplomacy, tact, and poise under pressure when working through issues
  • Collaborator in an environment of openness and trust through teamwork and self-accountability; offers support, training, and encouragement to others.
  • Applies experience, structured thinking, emerging knowledge, and trends to help solve problems logically.
  • Ability to prioritize and focus on activities that drive value.
  • Consistently meets or exceeds objectives and goals.
  • Track record of self-development and contributions to the function’s overall success.
  • Strong Excel, Word and PowerPoint skills are required.
  • A self-starter with high standards and has the ability to work independently.

Company Information

Vertex is a global biotechnology company that invests in scientific innovation.

Vertex is committed to equal employment opportunity and non-discrimination for all employees and qualified applicants without regard to a person's race, color, sex, gender identity or expression, age, religion, national origin, ancestry, ethnicity, disability, veteran status, genetic information, sexual orientation, marital status, or any characteristic protected under applicable law. Vertex is an E-Verify Employer in the United States. Vertex will make reasonable accommodations for qualified individuals with known disabilities, in accordance with applicable law.

Any applicant requiring an accommodation in connection with the hiring process and/or to perform the essential functions of the position for which the applicant has applied should make a request to the recruiter or hiring manager, or contact Talent Acquisition at