Associate Director of Chargeback Operations - Boston, United States - Vertex Pharmaceuticals, Inc

Description

Job Description

The Associate Director of Chargeback Operations is a critical role, reporting into the Director, Pricing, Analytics & Contract Management (PACM) team within the US Market Access organization.

This is an exciting opportunity for a subject matter expert that applies an enterprise-level mindset and technical expertise at the intersection of data, process optimization, automation, and innovation.

The ideal candidate is passionate about patients, focused on driving results, and is willing to be involved in hands-on execution while building new functional capabilities.

This role will interact with senior Commercial and Vertex leadership and the successful individual must be adept at cross-functional collaboration, while also having a high degree of attention to detail and accuracy to mitigate revenue leakage.

This role is expected to build out our chargeback function as we expand into new disease areas, operating with compliance and integrity and contributing to Vertex's corporate goals.

This is a hybrid/on-site role based in Boston, MA (3 days onsite, 2 days remote weekly).


Key Responsibilities:

• Play a critical role in setting up in-house chargeback function, working cross-functionally with 3PL, Trade & Distribution, Accounting, and DTE, etc. to develop policies, efficient processes, system requirements, and departmental SOPs.
• Partner with Government Pricing & Programs, Contract Operations, Payer Accounts and Legal, etc. to provide key insights during contracting strategy design, contract development, negotiation, and execution processes.
• Stay current with all promulgated and proposed federal regulations that could potentially impact chargeback and/or rebate adjudications, strategically assessing and communicating potential impact to current and/or future processes.
• Oversee and optimize the chargeback adjudication process, ensuring accuracy and compliance with industry regulations and internal SOX controls. Lead for SOX-related, internal, and external audits.
• Responsible for end-to-end contract administration operations, including Model N/Revitas contract set-up, membership management, and customer payment administration. Establish processes to ensure consistent translation of contract terms into operational solutions.
• Manage contract compliance, including timely verification of eligible members and/or plans and validation of customer policies to confirm rebate and chargeback eligibility.
• Respond to, research and address customer discrepancies and/or disputes to determine eligibility based on contractual terms within specified timeframes. Accurately and concisely deliver customer-centric communication in response to disputes.
• Support strategic assessments of the benefits and impact of automation or implementation of digital solutions to business-critical processes. Collaborate with DTE to Improve system(s) capabilities to meet evolving business requirements and seek process efficiencies.
• Model N/Revitas Chargeback module SME including capability to establish complex calculations within systems, or alternative manual spreadsheets if not systematically possible. Partner with DTE to manage enhancement backlog, trouble shoot issues.
• Research, review, and interpret complex data to evaluate performance criteria on a unit-by-unit and customer-by-customer basis, identify trends and key insights. Perform complex financial analytics to further execute and validate chargebacks to ensure accuracy.
• Partner with USMA Data & Analytics COE teams to create and maintain monthly and quarterly chargeback related reporting. Lead review and analysis of contractual payment activities, dashboards, and trends, collaborating with GTN Forecasting team on ad hoc analyses.

Minimum Qualifications:

• Bachelor's degree in a quantitative or technological discipline required (e.g., Engineering, Computer Science, Accounting, Statistics, Economics, Finance)
• 8+ years US pharmaceutical industry experience with increasing responsibilities in contract operations, contract management, financial analysis, chargeback validation, processing, and payments to FSS, Wholesalers, GPOs and IDNs.
• 5+ years' experience with managed care contract admin technology (i.e. Model N, EDI, Helix).
• Experience with in-house Chargeback departments preferably w/outsourced order to cash
• Proven ability to work in a fast-paced complex, customer-focused environment.
• Proven ability to build collaboration and drive problem-solving within and across teams.
• Proven ability to influence stakeholders through effective written and verbal communication.
• Excellent strategic thinker with analytical and solutions-driven mindset.
• Intellectual curiosity, active listener, and willingness to challenge the status quo and experiment when appropriate, focusing on continuous learning and improvement.
• Solid knowledge of Government Pricing calculations, Medicaid, Medicare and FSS.
• Strong business acumen, passion for innovation, ability to navigate ambiguity, and manages well through complexity. Excellent organizational skills and attention to detail.
• Effective communicator, someone who can inspire and energize people with ideas and ability to influence decision-makers through incisive analysis and persuasive communication.
• High level of proficiency in Microsoft applications, including Excel, PowerPoint and Word.

Preferred Qualifications:

• MBA, MPH or a Master's in a quantitative discipline.
• 8+ years in biotech/pharmaceuticals in a quantitative role in Managed Markets / Commercial / Finance / Investment Banking, or 3+ years in biopharma consulting (management, strategic or economic consulting) post-MBA/PhD, with meaningful biotech/pharmaceuticals with direct reports and quantitative decision support experience.
• Project management experience and familiarity with project management techniques.
• US product launch experience, cell and gene therapy a plus.
• Contract strategy implementation experience.
• Value based contract implementation experience highly preferred.
• Experience in working with senior leadership to support financial forecasting and analytics, and/or commercial launch planning.
• Knowledge of AI/ML tools, query languages/tools (SQL, Alteryx), blockchain technology and data visualization tools.

#LI-LN1

Company Information

Vertex is a global biotechnology company that invests in scientific innovation.

Vertex is committed to equal employment opportunity and non-discrimination for all employees and qualified applicants without regard to a person's race, color, sex, gender identity or expression, age, religion, national origin, ancestry, ethnicity, disability, veteran status, genetic information, sexual orientation, marital status, or any characteristic protected under applicable law.

Vertex is an E-Verify Employer in the United States. Vertex will make reasonable accommodations for qualified individuals with known disabilities, in accordance with applicable law.

Any applicant requiring an accommodation in connection with the hiring process and/or to perform the essential functions of the position for which the applicant has applied should make a request to the recruiter or hiring manager, or contact Talent Acquisition at