14 days old

Contract Compliance Analyst-Managed Care Contracting

Parsippany, NJ 07054
Company Info
Teva is a global pharmaceutical leader and the world's largest generic medicines producer, committed to improving health and increasing access to quality health solutions worldwide. Our employees are at the core of our success, with colleagues in over 80 countries delivering the world's largest medicine cabinet to 200 million people every day. We offer a uniquely diverse portfolio of products and solutions for patients and we've built a promising pipeline centered around our core therapeutic areas. We are continually developing patient-centric solutions and significantly growing both our generic and specialty medicines business through investment in research and development, marketing, business development and innovation. This is how we improve health and enable people to live better, healthier lives. Join us on our journey of growth!
Job Description

The purpose of the position is to identify and resolve compliance and eligibility issues with contracted managed care customers.  The position works with Teva Market Access account managers and contracted accounts to gain alignment on formulary product placement and compliance and to recover previously paid rebates or discounts in the event of noncompliant formulary findings.

 

The incumbent will be responsible for identifying and investigating formulary positions on PBM and Health Plan websites and formal Pharmacy Drug Lists (PDLs) to validate product placemernt complies with all terms and conditions of the managed care contract.  Using critical thinking skills and data analytics, the incumbent will complete complex investigational audit reviews, identify risks and compliance issues and present findings both verbally and in writing to key internal and external stakeholders.  In addition, the Contract Compliance Analyst will participate in identifying and recommending contracting strategy changes as related to the effectiveness of the contract terms and conditions.

 

The Contract Compliance Analyst reports to the Sr. Director, Contract Administration & Maintenance within Revenue Optimization and Contract Compliance (ROCC).

 

Major duties and responsibilities required to achieve the position's objectives and be successful in the Contract Compliance Analyst role:

 

  % of Time
  • Collaborates on design of annual audit plan to review top 80% of contracted account formularies across commercial, Medicare Part D, and managed Medicaid channels.
10%
  • Reviews Teva products on each formulary and assesses compliance within stated terms and conditions of contract.  Requests and obtains supporting documentation (prior authorizations, step edits, etc.) as needed to complete assessment.
60%
  • Maintains system to identify and track the status of all disputed records within each account and channel.  Reports compliance savings.
10%
  • Analyzes claim data to identify formulary outliers and assess financial impact of formulary noncompliance.
10%
  • Completes formulary assessment documents for Compliance Committee review.  Supports the Committee's compliance assessment.
10%

 

Qualifications

 

Education: Bachelor's Degree required

 

Required Experience:

 

  • Knowledge of Managed Care contracting as it relates to formulary access and tier position; Industry understanding of step-edits, NDC blocks, prior authorizations, copay differentials, preferred and non-preferred status is a plus.

 

  • Experienced in contract interpretation with specific focus on terms and conditions

 

  • Basic understanding of pharmaceutical rebate flow and decision points

 

  • Minimum 3-5 years experience in financial analysis

 

  • Minimum 1-2 years experience working with drug formularies

 

  • Advanced Excel skills

 

Preferred Experience:

 

  • Brand pharmaceutical business, specifically in market access

 

  • Negotiation and presentation skills

 

  • Understanding of drug purchase discounts and interaction with Rx based rebates

 

Core Competencies

 

Analysis

 

  • Analyzes large data sets looking for anomalies and aberrant trends

 

  • Ability to see relationships in data and arrive at cause and effect

 

  • Detail oriented, ability to see errors and verify the correctness of the analysis

 

Autonomy & Problem Solving

 

  • Is a self-starter, works autonomously and takes initiative

 

  • Ability to identify actions necessary to achieve task completion

 

  • Solves problems interdependently, seeks out other perspectives

 

  • Takes personal responsibility for results and quality of work

 

Communication and Influence

 

  • Ability to communicate effectively both verbally and in writing

 

  • Presents information that will have a strong effect on others

 

  • Presents arguments that address others' concerns

 

  • Builds coalition to support best solutions and recommendations

 

Planning and Organization

 

  • Has a strong sense of urgency about meeting deadlines

 

  • Ability to manage several projects at one time

 

  • Demonstrates ability to re-prioritize workload based on new commitments

 

  • Organizes work so that others can follow development and conclusions
Function
Marketing
Sub Function
Managed Care Administration
Reports To

Senior Director, Contract Administration & Maintenance

Tevas Equal Employment Opportunity Commitment
Teva Pharmaceuticals is committed to equal opportunity in employment. It is Teva's global policy that equal employment opportunity be provided without regard to age, race, creed, color, religion, sex, disability, pregnancy, medical condition, sexual orientation, gender identity or expression, ancestry, veteran status, national or ethnic origin or any other legally recognized status entitled to protection under applicable laws.

Categories

Posted: 2019-11-07 Expires: 2019-12-21

Join us at the forefront of pharmaceutical research and production. With state-of-the-art facilities, highly skilled colleagues, and a high-powered organizational culture, Teva offers you countless possibilities to make a real difference in people's lives and add value to your career.

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Contract Compliance Analyst-Managed Care Contracting

Teva Pharmaceuticals
Parsippany, NJ 07054

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