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The Medicaid Program Specialist will be responsible for coordinating the day-to-day operations of Purdue’s Medicaid drug rebate payment program obligations governed by Purdue’s master service agreement with the Center for Medicare and Medicaid Services (CMS) Medicaid Drug Rebate Program and governing regulations.
- Collaborate with Purdue’s third-party Medicaid processing vendor to validate all state Medicaid rebate invoices in accordance with industry best practices and within their respective payment deadlines and coordinate payments to the States.
- Validate Medicaid payment packages for accuracy.
- Manage state Medicaid invoice identification of disputes, and implement and monitor dispute tracking log, and liaise with States and Purdue’s third-party Medicaid processing vendor on dispute identification and resolution.
- Build and maintain strong State and Pharmacy Benefit Administrator relationships and manage the relationships with state Medicaid agencies.
- Manage the Medicaid dispute resolution process to maintain current and accurate books between Purdue and state Medicaid agencies.
- Perform trending analysis and invoice reconciliation to identify utilization disparities, and abnormal trends, and research trends with states.
- Calculate and validate state supplemental rebate and State Pharmaceutical Assistance Program (SPAP) invoice amounts.
- Have an understanding of Purdue’s Revitas Flex Medicaid system, train other users on software.
- Support Purdue’s third-party Medicaid processing vendor with testing of new software due to government pricing systems upgrades and/or changes in pricing methodology.
- Ensure all invoice data is properly archived and maintained in order to comply with all Federal guidelines and audit requirements.
- Perform financial modeling to aide in financial accruals process related to Medicaid rebate liability, and to support inquiries from other company stakeholders.
- Update and maintain SOPs as appropriate.
- Depending on skill set, provide back up support to government pricing functions for the calculation of Average Manufacturer Price (AMP), Best Price (BP), and potentially other government price reporting obligations.
Education And Experience Requirements
- Minimum 3-5 years of industry experience in healthcare, pharmaceutical and/or medical device industry preferred
- Minimum 2 years of experience working in the areas of, Medicaid, government pricing, rebate adjudication, contract management process/systems, document control, etc.
- Bachelor’s degree
Necessary Knowledge, Skills, And Abilities
- Technical Skills: Proficient in Outlook, MS Excel and MS Word. Knowledge of SAP and Revitas Flex Medicaid / Contract Sphere or other pharmaceutical contract/rebate/membership systems a plus. Must possess technical skills sufficient to learn new systems, understand system functionality well, and test systems when required.
- Market understanding – Good understanding of the Medicaid Drug Rebate Program, and general understanding of government price calculations such as Average Manufacturer Price (AMP), Medicaid Best Price (BP) and reporting processes. Understanding of the involvement of legal/regulatory and compliance in the government market. Proven understanding of current health care environment, regulations, and health care reform laws.
- Contract Interpretation – Ability to understand and interpret contract language related to government price calculations.
- Organization skills – Must possess good capability of organizational skills and ability to manage multiple projects at one time. Ability to adjust to changing needs within the organization and flexibility to change priorities as needed. Must be able to work under strict deadlines.
- Communication – Must possess strong written and verbal communication skills to interact with external and internal customers.
- Analytics: must be good with numbers, able to analyze data and trends and data discrepancies, good critical reasoning skills. Strong analytical skills and attention to detail with the capability to appropriately define issues, questions data; to comprehend qualitative and quantitative methods to perform accurate analysis. Ability to creatively think about different problems and devise pragmatic solutions.
- Strong interpersonal skills with demonstrated ability to work well with others, manage work with counterpart(s) at Purdue and drive towards consensus.
- Attention to detail and deadlines, a strong work ethic, and a history of adherence to policies and procedures are critical.
Physical And Environmental Requirements
- Perform job functions in various positions that may require sitting, stooping, balancing, kneeling, crouching, twisting, and/or reaching. While sitting for an extended period of time on a routine basis, incumbent may use the following equipment: Personal computer, telephone/ other voice communication devices, copier, fax, scanners, or other specialized equipment used in an office setting.
- Work-flex roles can be performed through a combination of on-site and remote-based work.
- Employee should be located in the following states: CT, NJ, NY
- Relocation assistance not provided.
Minimum required education, experience, knowledge, skills and abilities are included in the posting. The position will be filled at the level commensurate with the successful candidate’s education, experience, knowledge, skills, and abilities.
The job description is not an exhaustive list of all functions that the employee may be required to perform, and the employee may be required to perform additional functions. Additionally, the company may revise the job description at any time.