Rebate Analyst, Managed Care Rebate Operations

About the role

This role is responsible for contract administration, data validation, analysis, processing, and payment of rebates associated with Managed Care contracts. Primary duties include interpretation and evaluation of contract terms, claims eligibility validation, formulary verification, rebate adjudication, and external customer management to ensure proper determination and payment of contracted rebates.

Responsibilities

• Review executed paper contract, develop summary of contract terms, and set up contract to accurately reflect the intent of the contract.
• Maintain Managed Care rebate contracts including contract terms, membership, and formulary status.
• Review and validate submitted Managed Care rebate claims data and make decisions on claims eligibility based on plan formulary status and compliance.
• Calculate rebates on eligible claims, review for accuracy through thorough analysis and resolution of discrepancies, and make decisions on final payment due to customer per contract terms.
• Collaborate with Contract Operations team, as needed, to ensure the intent of the contract is carried out in the rebate calculations and payments.
• Provide analytical thinking and business acumen to identify and resolve variances in claims data trends or expected rebate rates.
• Evaluate invoices for year-to-date rebate payment trends and provide explanations for variances vs. prior periods. Escalate unexplained variances which may indicate potential compliance or performance issues to leadership.
• Prepare payment packages and process payments. Resolve outstanding issues to ensure payments are made within the contractual timeframe.
• Monitor drug formulary compliance.
• Serve as primary contact with external customers (payers) and Contract Operations team to address questions or resolve issues. Gather supporting facts and make recommendations for dispute resolution for approval by management.
• Apply process-oriented and critical thinking to enhance organizational effectiveness of accurate and timely contract administration and rebate processing. Revise SOPs as required to reflect process improvements.
• Maintain compliance with SOX and audit controls governing contract and rebate operations.
• Assist in fulfilling requirements related to internal/external audits of systems and processes, legal requests, and government agency inquiries.

Qualifications

• 0-2 years of experience in one of the following: contract administration, rebate processing, or business/financial analysis.
• Experience with analytical techniques to determine reasonableness of data, trends, and the root cause of issues.
• Demonstrated strong organizational skills.
• Proven ability to multitask and make rapid decisions when discrepancies or non-routine situations arise.
• Effective communication skills and experience dealing with both internal and external customers while obtaining complete/accurate information.
• Flexible, team player open to collaborating across team assignments and ad-hoc projects.
• Proficiency in MS Office (Excel, Access).
• Managed Care experience is preferred.
• BA/BS degree is preferred.

Pay

Madison - Giralda - NJ - US: $69,120 - $83,760
Princeton - NJ - US: $69,120 - $83,760

The starting compensation range(s) for this role are listed above for a full-time employee (FTE) basis. Additional incentive cash and stock opportunities (based on eligibility) may be available. The starting pay rate takes into account characteristics of the job, such as required skills, where the job is performed, the employee’s work schedule, job-related knowledge, and experience. Final, individual compensation will be decided based on demonstrated experience.

Benefits

• Health Coverage: Medical, pharmacy, dental, and vision care.
• Wellbeing Support: Programs such as BMS Well-Being Account, BMS Living Life Better, and Employee Assistance Programs (EAP).
• Financial Well-being and Protection: 401(k) plan, short- and long-term disability, life insurance, accident insurance, supplemental health insurance, business travel protection, personal liability protection, identity theft benefit, legal support, and survivor support.
• Work-life Benefits:
  • Paid Time Off for US Exempt Employees: Flexible time off (unlimited, with manager approval), 11 paid national holidays (not applicable to employees in Phoenix, AZ, Puerto Rico, or Rayzebio employees).
  • Phoenix, AZ, Puerto Rico, and Rayzebio Exempt, Non-Exempt, Hourly Employees: 160 hours annual paid vacation for new hires with manager approval, 11 national holidays, and 3 optional holidays.
  • Additional time off for employees may include unlimited paid sick time, up to 2 paid volunteer days per year, summer hours flexibility, leaves of absence for medical, personal, parental, caregiver, bereavement, and military needs, and an annual Global Shutdown between Christmas and New Year’s Day.

All global employees full and part-time who are actively employed at and paid directly by BMS at the end of the calendar year are eligible to take advantage of the Global Shutdown.

Schedule

This role follows BMS’s occupancy structure, which determines where an employee is required to conduct their work. The occupancy type is determined by the nature and responsibilities of the role:

• Site-essential roles: Require 100% of shifts onsite at your assigned facility.
• Site-by-design roles: May be eligible for a hybrid work model with at least 50% onsite at your assigned facility. Onsite presence is considered an essential job function and is critical to collaboration, innovation, productivity, and a positive company culture.
• Field-based and remote-by-design roles: The ability to physically travel to visit customers, patients, or business partners and to attend meetings on behalf of BMS as directed is an essential job function.