A leading US biopharmaceutical organisation with a solid commercial portfolio of life-saving drugs within a number of therapy areas have a new Contract Analyst job opportunity at their offices in California, USA. The company has a growing pipeline of investigational drugs and approximately 5,000 employees in offices across four continents.
Role and Requirements:
- Establish contracts (e.g., rebates, administrative fees, chargebacks, etc.) within operations systems based on terms and conditions in customer agreements.
- Monitor contract requirements to ensure customers remain in compliance with contract terms and conditions.
- Communicate directly with internal customers and external customers (wholesalers/distributors and state Medicaid/ADAP agencies, and other depts.) to ensure that accurate pricing and discounts are being extended and to coordinate on resolution of customer issues in a timely manner.
- Proactively review claims to identify possible disputes of incoming utilization and/or sales data and effectively resolve issues.
- Maintain contract parameters within contracting operational systems including customer membership/affiliations, products, prices, performance tiers, date ranges, and incentive percentages.
- Import/enter customer utilization data needed to support the proper calculation of earned non-purchase incentives. Make sure the data is scrubbed (error checking/handling) and loaded correctly into the operational systems.
- Develop and execute data entry/import control procedures for all non-purchase utilization data sources.
- Effectively resolve all claims in an accurate and timely manner. Proactively review, analyze, and establish claim processing standard operating procedures as needed to ensure claims are processed according to company policies and contractual obligations.
- Implement industry standards and develop specific dispute tests to isolate high potential dispute target claim line items.
- Work with commercial and government customers to resolve outstanding disputes in a timely manner. Provide management with dispute tracking and win/loss reports in a timely manner.
- Review, revise, and establish claim payment standard operating procedures as needed to ensure the accuracy and timeliness of claim payments. Track all payments made through internal systems and link payments to claim requests to ensure proper payments are made.
- Effectively resolve chargeback submissions timely and accurately, including the research and reconciliation of exceptions/errors. Communicate with wholesalers and end customers in the reconciliation process.
- Proactively identify potential issues and inefficiencies that arise in the areas of chargebacks, and offer recommendations and solutions.
- Load contracts (customer, products, pricing, eligibility, dates) into contract management system and verify accuracy of all data.
- Responsible for the maintenance of contract data and eligibility to be fully compliant with contract agreements.
- Communicate new and updated contract data to wholesalers in a timely manner such that accurate pricing will be extended to eligible contract customers.
- Minimize the volume and amount of wholesaler chargeback deductions.
- Effectively collaborate with internal business teams (Government Pricing, Accounting, Finance, IT) to ensure transaction, exceptions/errors, and deductions are processed and resolved accurately and timely.
- Work with IT, systems vendors and consultants to design and implement system fixes/enhancements.
- Experience processing chargebacks in Model N or I-many contract management systems is a plus.
Knowledge, Experience and Skills:
- Working knowledge of claim processing principals, techniques and their appropriate application.
- Strong proficiency in Microsoft Excel//Word/PowerPoint and of 3rd party claim processing tools (e.g., Imany, Model N, etc.). Knowledge of Microsoft Access a plus.
- Bachelor's degree in business administration, marketing finance or related field. 4-5 years of experience in a utilization-based claim processing environment in the pharmaceutical or biotech industry.
Please click on the Apply button. Please include a short note outlining why you are interested in the role and why you think you are suitable.
In case you have difficulty in applying or if you have any questions, please call Christopher Frank on +1 267 405 6996or upload your CV on our website www.proclinical.com.
A full job description is available on request.
ProClinical is a specialist employment agency and recruitment business, providing job opportunities within major pharmaceutical, biopharmaceutical, biotechnology and medical device companies.