- Establishes audit plan to review top 80% of contracted account formularies across commercial, Medicare Part D, and managed Medicaid channels.
- Reviews Teva products on each formulary and assesses compliance within stated terms and conditions of contract. Requests and obtains supporting documentation (prior authorizations, step edits, etc.) as need to complete assessment.
- Maintains system to identify and track the status of all disputed records within each account and channel. Reports compliance savings.
- Analyzes claim data to identify formulary outliers and to assess financial impact of formulary noncompliance
- Completes formulary assessment documents for Compliance Committee review. Supports their compliance assessment.
- Minimum 2-3 years' experience working in a Pharmacy Technician role
- Thorough understanding of Managed Care contracting as it relates to formulary access and tier position; Industry understanding of step-edits, NDC blocks, prior authorizations, copay differentials, preferred and non-preferred status is a plus.
- Ability to articulate comprehensive understanding of contract terms and conditions
- Advanced understanding of pharmaceutical rebate flow and decision points
- Minimum 5-7 years' experience in financial analysis.
- Minimum 2-3 years' experience working with drug formularies
- Advanced Excel skills
- Brand pharmaceutical business, specifically in market access
- Negotiation and presentation skills
- Understanding of drug purchase discounts and interaction with Rx based rebates
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Sr. Contract Compliance Analyst III - Parsippany, United States - Teva Pharmaceutical Industries
Description
Who we are
Together, we're on a mission to make good health more affordable and accessible, to help millions around the world enjoy healthier lives.
It's a mission that bonds our people across nearly 60 countries and a rich, diverse variety of nationalities and backgrounds.
Working here means working with the world's leading manufacturer of generic medicines, and the proud producer of many of the products on the World Health Organization's Essential Medicines List.
Today, at least 200 million people around the world take one of our medicines every single day.An amazing number, but we're always looking for new ways to continue making a difference, and new people to make a difference with.
The opportunityThe 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 Sr.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.
The Sr. Contract Compliance Analyst reports to Sr. Director Contract Compliance within the Revenue Optimization and Contract Compliance group. (ROCC).How you'll spend your day
Major duties and responsibilities required to achieve the position's objectives and be successful in the Sr
Contract Compliance Analyst role:
Education:
Bachelor's Degree Required, MBA Preferred
Experience Required:
Preferred Experience:
We are strengthening and adding to our critical teams with great talent and capabilities: Teva, a global organization with a brand of evolving success.
We offer a competitive benefits package, including Medical, Dental, Vision, and Prescription coverage starting on the first day.
We also offer Disability and Life Insurance, Paid Time Off, 13 paid Holidays, 6% match on the 401(k), Employee Stock Purchase Plan, and Tuition Assistance.
Already Working @TEVA?If you are a current Teva employee, please apply using the internal career site available on "Employee Central". By doing so, your application will be treated with priority. You will also be able to see opportunities that are open exclusively to Teva employees.
Use the following link to search and apply:
Internal Career Site
The internal career site is available from your home network as well. If you have trouble accessing your EC account, please contact your local HR/IT partner.
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, veteran status, national or ethnic origin or any other legally recognized status entitled to protection under applicable laws.
We are committed to a diverse and inclusive workplace for all.If you are contacted for a job opportunity, please advise us of any accommodations needed to support you throughout the recruitment and selection process.
All accommodation information provided will be treated as confidential and used only for the purpose of providing an accessible candidate experience.
