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Senior Manager Managed Care

Date: Jan 17, 2019

Location: Parsippany, New Jersey, US, 07054

Company: Teva Pharmaceuticals

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

Position Summary:  

The SRr. Manager, Medicaid Claims Administration leads department staff in processing of Medicaid rebate claims and resolve disputes in accordance with the terms and conditions of the rebate contract and CMS guidelines for all Teva brand and generic products.  This position is responsible to provide first level approval, as required by SOX, of all outbound claim documents for accuracy (dollars & coding) and completeness.  This position also provides key role in supporting of rebate/cash forecasting, government reporting, process improvement, system upgrade/implementation and ad hoc analysis.

The Sr. Manager, Medicaid Claims Administration reports to the Director, Medicaid & Analytics. This position is a Shared Service position and provides support for all Teva products.

 

Essential Duties & Responsibilities 

 

  1. Review and approve all outbound claims to ensure accuracy and completeness; and minimize revenue leakage
  1. Provide guidance to staff in resolution of disputes with states.  Escalate material unresolved issue to direct manager
  1. Find ways to simplify / standardize claim processing including leverage new technologies and systems.
  1. Setup new programs / contracts and perform system maintenance in Model N systems.
  1. Perform accurate weekly cash forecast of Medicaid payment and develop standard Medicaid reports such as Open balance, Workflow report, Past Due and Disputes.
  1. Stay on top of CMS Medicaid rule changes.  Establish and maintain policies, procedures, and standards for Medicaid Rebate Processing in support of SOX, internal/external financial reporting, and government regulations.
  1. Assist with special projects, system implementation and Ad hoc reports.
  1. Hire, train and retains high performing staff. 

Qualifications

Position Requirements

 

Education Required:

 

 

 

Bachelor’s Degree Required

 

Education Preferred

MBA preferred

 

Experience Required:

Minimum of 5-7 years of Medicaid Claim processing experience with Pharmaceutical company , state and/or state agency or as Medicaid consultants

 

Experience Preferred:

Pharmaceutical Industry experience ; Medicaid Claim processing function; manipulation of large datasets, negotiation/conflict resolution.  System Implementation and report writing.

 

Specialized or Technical Knowledge, License, Certifications needed:

Must have Intermediate to advanced knowledge of the Model N or Revitas/Flex Medicaid and/or Flex Validata system (or other comparable system) and advance Microsoft Excel skills. 

Familiar with CMS Medicaid rules and state specific issues.  Up to date knowledge on Medicaid Validation rules and issues with 340B covered entities.

SAP, Business Intelligence, Oracle Discoverer, Tableau preferred.  Strong ability to organize and manipulate large volume of data in various formats.

Function

Marketing

Sub Function

Managed Care Administration

Reports To

Position Requirements

 

Education Required:

 

 

 

Bachelor’s Degree Required

 

Education Preferred

MBA preferred

 

Experience Required:

Minimum of 5-7 years of Medicaid Claim processing experience with Pharmaceutical company , state and/or state agency or as Medicaid consultants

 

Experience Preferred:

Pharmaceutical Industry experience ; Medicaid Claim processing function; manipulation of large datasets, negotiation/conflict resolution.  System Implementation and report writing.

 

Specialized or Technical Knowledge, License, Certifications needed:

Must have Intermediate to advanced knowledge of the Model N or Revitas/Flex Medicaid and/or Flex Validata system (or other comparable system) and advance Microsoft Excel skills. 

Familiar with CMS Medicaid rules and state specific issues.  Up to date knowledge on Medicaid Validation rules and issues with 340B covered entities.

SAP, Business Intelligence, Oracle Discoverer, Tableau preferred.  Strong ability to organize and manipulate large volume of data in various formats.

Teva’s 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, national or ethnic origin or any other legally recognized status entitled to protection under applicable laws.


Nearest Major Market: New York City
Nearest Secondary Market: Newark