Lead Formulary Compliance Analyst - Parsippany, NJ (Hybrid)
Parsippany, United States, New Jersey, 07054
Who we are
The opportunity
The purpose of the position is to identify and resolve compliance and eligibility issues with contracted managed care customers. This position works with the Teva Market Access account managers and the contracted account to gain alignment on formulary product placement and compliance and to recover previously paid rebate or discounts in the event of noncompliant formulary findings.
Reporting to the Director, Contract Compliance, the incumbent will be responsible for identifying and investigating formulary positions on PBM and Health Plan websites and formal Pharmacy Drug Lists (PDL) to validate product placement 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 Sr. Contract Compliance Analyst will participate in identifying and recommending contracting strategy changes as it relates to the effectiveness of the contract terms and conditions.
How you’ll spend your day
- Establish an audit plan to review the top 80% of contracted account formularies across Commercial, Medicare Part D, and Managed Medicaid channels
- Review Teva products on each formulary and assess compliance with the stated terms and conditions of contract; request and obtain supporting documentation (e.g., prior authorizations, step edits etc.) as needed to complete the assessment
- Support post-audit reviews and prepare ad-hoc analysis for account-related disputes
Your experience and qualifications
Required:
- Thorough understanding of Managed Care contracting as it relates to formulary access and tier positioning; Industry understanding of step-edits, NDC blocks, prior authorizations, copay differentials, preferred and non-preferred status is a plus
- Ability to articulate a comprehensive understanding of contract terms and conditions
- Advanced understanding of pharmaceutical rebate flow and decision points
- 340B knowledge is a plus
- Minimum of 3 years’ experience in financial analysis
- Minimum of 2 years’ experience working with drug formularies
- Superior skills in Excel and PowerPoint
Preferred:
- Experience in brand pharmaceutical business, specifically in market access, rebate operations, and/or pharma contract compliance
- Strong negotiation and presentation skills
- Understanding of drug purchase discounts and their interaction with Rx based rebates
Compensation data
The annual starting salary for this position is between $97,400 – 127,800 annually. Factors which may affect starting pay within this range may include geography/market, skills, education, experience and other qualifications of the successful candidate.
Enjoy a more rewarding choice
We offer a competitive benefits package, including:
- Comprehensive Health Insurance: Medical, Dental, Vision, and Prescription coverage starting on the first day of employment, providing the employee enrolls.
- Retirement Savings: 401(k) with employer match, up to 6% and an annual 3.75% Defined Contribution to the 401k plan
- Time Off: Paid Time Off including vacation, sick/safe time, caretaker time and holidays
- Life and Disability Protection: Company paid Life and Disability insurance
- Additional benefits include, but are not limited to, Employee Assistance Program, Employee Stock Purchase Plan, Tuition Assistance, Flexible Spending Accounts, Health Savings Account, Life Style Spending Account, Volunteer Time Off, Paid Parental Leave, if eligible , Family Building Benefits, Virtual Physical Therapy, Accident, Critical Illness and Hospital Indemnity Insurances, Identity Theft Protection, Legal Plan, Voluntary Life Insurance and Long Term Disability and more
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