Alkermes, Inc. is the U.S. operating company of Alkermes plc, a fully integrated, global biopharmaceutical company that applies its scientific expertise and proprietary technologies to research, develop and commercialize, both with partners and on its own, pharmaceutical products that are designed to address unmet medical needs of patients in major therapeutic areas. Alkermes has a diversified portfolio of marketed products focused on central nervous system disorders such as addiction and schizophrenia and a pipeline of product candidates in the fields of neuroscience and oncology. Headquartered in Dublin, Ireland, Alkermes has a research and development (“R&D”) center in Waltham, Massachusetts; an R&D and manufacturing facility in Athlone, Ireland; and a manufacturing facility in Wilmington, Ohio.
The following position is for Alkermes, Inc.
The Manager, Medicaid Operations – Contracts & Pricing, will lead and support the Medicaid team’s day-to-day operations and other key processes within the Contract & Pricing department. Areas of ownership include but are not limited to overseeing and performing Medicaid claims processing, contract maintenance, data management, report generation, trend analyses, documentation, and cross-departmental collaboration.
The position reports to the Manager, Government Rebate Operations.
Key Responsibilities
- Lead, perform and continually enhance the end-to-end Medicaid claims adjudication process
- Review and update of Medicaid Rebate Processing system (MRB) in Model N®
- Setup and maintenance of Medicaid Contracts terms and prices
- Analyze rebate calculations for consistency and accuracy, research variances, and resolve disputes
- Communicate with state Medicaid contacts regarding payments and disputes as needed
- Execute various Medicaid state reporting activities required for data reconciliation
- Identify and assist in process and system improvements
- Ensure Preferred Drug List (PDL) status is verified every quarter
- Ensure proper Claim Level Detail (CLD) analysis and validation without oversight
- Prepare and provide Medicaid rebate reports and trend analyses to internal stakeholders
- Collaborate with Alkermes teams to support necessary updates to systems in accordance with guidance from CMS, OIG, OPA, and other regulating entities
- Support ongoing ad hoc requests and projects
Other Areas Of Focus Include
- Review, maintain and improve existing Standard Operating Procedures (SOPs) and Work Instructions (WIs)
- Ensure TriCare, IFF, and Coverage Gap payments are accrued for and paid within the mandated timeline
- Work with vendor / consultants as needed
- Participate in the internal and external audit related process (accruals, financial close process, etc.)
- Limited travel to home office may be required based on business needs
- Attend conferences and industry meetings as necessary (est. 5% to 10% travel)
- Bachelor’s degree required (Master’s degree a plus)
- 8+ years of professional experience
Preferred Skills And Knowledge Requirements
- 5+ years of pharmaceutical manufacturer Medicaid experience preferred
- 3+ years of RMS experience (e.g., Model N®, Revitas, or similar platform) preferred
- Expertise in MS Excel, PowerPoint, and Word
- Strong organizational, analytical, and communication skills
- Effective time management capabilities
- Understanding of the current healthcare landscape
- Experience managing full-time direct-reports a plus
- Understanding corporate finance is a plus
Alkermes, Inc. is an equal employment opportunity employer and does not discriminate against any applicant because of race, creed, color, age, national origin, ancestry, religion, gender, sexual orientation, gender expression and identity, disability, genetic information, veteran status, military status, application for military service or any other class protected by state or federal law. Alkermes also complies with all work authorization and employment eligibility verification requirements of the Immigration and Nationality Act and IRCA. Alkermes is an E-Verify employer.
Experience Level
Mid-Senior Level