Sr. Manager, Medicaid Contract Administration

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, and a diverse pipeline of early- to late-stage assets, 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 Sr. Manager, Medicaid Contract Administration. This position is responsible for managing the Medicaid rebate team in receiving, processing, validating, trouble-shooting Medicaid claims and dispute resolution with state agencies. This position requires a detailed understanding of the life science industry specific to the Medicaid payer landscape. The decisions made in this position affect company sales, pricing discounts, and best price implications. This role also facilitates working relationships with both internal and external customers.

Job Duties & Responsibilities

• Lead operations person for all Medicaid decisions as it relates to Model N implementation and payment process.
• Experience in processing Medicaid rebates preferably using Model N software application or other similar industry standard software.
• Investigate, analyze information, and resolve business questions by applying information from various data sources, business rules and system processes.
• Ability to understand and perform complex rebate and best price calculations.
• Able to foster and maintain constructive working relationships with customers while resolving business issues dealing with data correctness.
• Interact with internal departments (Internal Audit, Commercial Insights, Contracting, SOX Compliance, and Legal) to clarify policy compliance requirements and contract language clauses.
• Keep current on regulatory and industry changes that may impact Medicaid operations.
• Oversee the Medicaid Dispute Resolution process.
• Keen attention to detail and ability to conduct repetitive transactions and processes using computer systems.
• Identifies and resolves discrepancies in submitted data invoices to ensure legitimacy of contract discounts.
• Ensures detailed accuracy of correct data input into company systems.
• Maintains service standards in processing data submitted by customers and proactively advises management of issues.
• Able to identify and recommend improvements in business procedures and outcomes.
• Create and maintain ongoing SOP documentation for department processes and confirm adherence to final policies and system requirements.
• Train staff on Medicaid landscape and Model N system navigation.
• Manage a staff with a concentration on career development.
• Performs other responsibilities as assigned.

Key Core Competencies

• Six plus years’ experience in the healthcare/pharmaceutical industry.
• Knowledge and experience in common industry software programs (i.e., Model N).
• Has experience in processing Medicaid rebates preferably using Model N software application or other similar industry standard software.
• Able to investigate, analyze information, and resolve business questions by applying information from various data sources, business rules and system processes.
• Proficient in MS Office (Word, Excel, Access, PowerPoint, MS Project, Visio, SharePoint).
• Customer-focused ability to communicate across all levels of the organization.
• Excellent written skills required.
• Strong problem solving, critical thinking, communication, and sound judgment skills.
• Solid experience in supporting System/application jobs and troubleshooting production issues in complex software solutions.
• Fast paced environment handling multiple demands.
• Must be able to exercise appropriate judgment as necessary.
• Requires