Sumitomo Pharma Co., Ltd. is a global pharmaceutical company based in Japan with key operations in the U.S. (Sumitomo Pharma America, Inc.), Canada (Sumitomo Pharma Canada, Inc.) and Europe (Sumitomo Pharma Switzerland GmbH) focused on addressing patient needs in oncology, urology, women's health, rare diseases, psychiatry & neurology, and cell & gene therapies. With several marketed products in the U.S., Canada, and Europe, a diverse pipeline of early- to late-stage assets, and in-house advanced technology capabilities, we aim to accelerate discovery, research, and development to bring novel therapies to patients sooner. For more information on SMPA, visit our website https://www.us.sumitomo-pharma.com or follow us on LinkedIn.
Job Overview
We are currently seeking a dynamic, highly motivated, and experienced individual for the position of Analyst, Medicaid Rebates. This individual contributor role is responsible for processing Medicaid State, Supplemental and SPAP rebate invoices in accordance with the requirements outlined in the Medicaid Drug Rebate Program or program contract.
This individual will review utilization by these programs to identify potential disputes and will work with states and or their appointed contractors to resolve disputes and to clean up historical utilization that is routinely submitted with Medicaid claims. In addition, the analyst will load Medicaid claim information into the Commercial Validata system to prevent revenue leakage by scrubbing for duplicate claims across channels. The position will also provide operational and cooperative support to the Market Access team.
Job Duties and Responsibilities
- Process Medicaid State, MCO & SPAP rebate payments using the Model N software or similar application. Enter/upload all invoice information, review trending against prior periods, prepare payment packages, coordinate approval process, provide backup documentation and follow up with A/P to ensure all payments are completed on time
- Maintain the Model N or similar Medicaid system- calculate Medicaid Unit Rebate Amounts (URA’s), update contracts, CPIU and T-Bill updates, participate in UAT of system upgrades and service patches
- Request and review claim level detail (CLD) to confirm validity of rebate invoices. Work with large amounts of data and be able to analyze for anomalies, outliers, patterns, and trends
- Uploads CLD into Commercial Validata module to scrub for duplicate claims across channels
- Initiate disputes with states when warranted
- Communicate unusual invoicing activity to management and internal stakeholders
- Investigate, analyze information, and resolve business questions and disputes by applying information from various data sources, business rules and system processes
- Understand the specific differences in Medicaid invoicing and CLD state by state and able to recommend and adjust processes to accommodate differences
- Foster and maintain constructive working relationships with State contacts and invoice intermediaries while resolving business issues with invoicing and data inaccuracies. Communicate and resolve discrepancies in these situations with minimal supervision while maintaining positive relationships and professionalism
- Maintain service standards in processing data and proactively advise management of issues
- Maintain status reports and update numerical information in spreadsheets
- Adhere to SOP’s, Work Instructions, and SOX control documents as they relate to department business processes and update documents as needed
- Identify and recommend improvements in business procedures and outcomes
- Perform other responsibilities as assigned
Key Core Competencies
- Knowledge of and experience with common industry software programs (i.e. CARS/IS Classic and Revitas Flex, Model N or other similar industry standard software)
- Must have keen attention to detail and ability to conduct repetitive transactions and processes using computer systems
- Must have fundamental knowledge of pharmaceutical product contract agreements
- Must have proficiency in working with Microsoft Office products (Excel, Word, Outlook)
- Able to investigate, analyze information and resolve business questions by applying information from various data sources, business rules and system processes
- Solid knowledge of pharmaceutical product contract agreements and the Medicaid Regulatory environment
- Excellent organizational and communication skills (verbal and written)
Education and Experience
- Minimum education required: HS Diploma. Bachelor’s or associate degree preferred.
- Three years general business experience or two years specific experience in a pharmaceutical company environment preferred
The base salary range for this role is $70,000 to $87,500. Base salary is part of our total rewards package which also includes the opportunity for merit-based salary increases, short incentive plan participation, eligibility for our 401(k) plan, medical, dental, vision, life and disability insurances and leaves provided in line with your work state. Our robust time-off policy includes unlimited paid time off, 11 paid holidays plus additional time off for a shut-down period during the last week of December, 80 hours of paid sick time upon hire and each year thereafter. Total compensation, including base salary to be offered, will depend on elements unique to each candidate, including candidate experience, skills, education and other factors permitted by law.
Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.
Confidential Data: All information (written, verbal, electronic, etc.) that an employee encounters is considered confidential.
Compliance :Achieve and maintain Compliance with all applicable regulatory, legal and operational rules and procedures, by ensuring that all plans and activities for and on behalf of Sumitomo Pharma America (SMPA) and affiliates are carried out with the "best" industry practices and the highest ethical standards.
Mental/Physical Requirements: Fast paced environment handling multiple demands. Must be able to exercise appropriate judgment as necessary. Requires a high level of initiative and independence. Excellent written and oral communication skills required. Requires ability to use a personal computer for extended periods of time.
Sumitomo Pharma America (SMPA) is an Equal Employment Opportunity (EEO) and Affirmative Action employer
Sumitomo Pharma America (SMPA) is committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race; color; creed; religion; national origin; age; ancestry; nationality; marital, domestic partnership or civil union status; sex, gender, gender identity or expression; affectional or sexual orientation; disability; veteran or military status or liability for military status; domestic violence victim status; atypical cellular or blood trait; genetic information (including the refusal to submit to genetic testing) or any other characteristic protected by law.
For more information about EEO and the Law, please visit the following pages:
Equal Employment Opportunity is THE LAW
EEO is the Law Poster Supplement
Pay Transparency
