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Chargeback Analyst II
Essential Duties and Job Functions:
• Effective communicator with the ability to communicate directly with internal and external customers (wholesalers/distributors and state Medicaid/ADAP agencies, and other depts.) to ensure that accurate pricing and discounts are being extended and to coordinate on resolution of customer issues in a timely manner.
• Monitor contract requirements to ensure customer and Gilead remain in compliance with contract terms and conditions.
• Ability to solve problems independently with little supervision but within departmental guidelines.
• Maintain contract parameters within Gilead's contracting operational systems including customer membership/affiliations, products, prices, performance tiers, date ranges, and incentive percentages.
• Effectively resolve all claims in an accurate and timely manner. Proactively review, analyze, and establish claim processing standard operating procedures as needed to ensure claims are processed according to company policies and contractual obligations.
• Develop reports and analysis to support metric tracking statistics to departmental management as requested in order to keep them advised as to the status, volume, and potential liability of future rebate, fee, and other payments.
• Memorize and consistently apply internal Gilead rules for data creation and maintenance in order to ensure Gilead is compliant with government and commercial pricing programs.
Knowledge, Experience and Skills:
• Excellent communication skills, strong verbal, written and interpersonal skills with an emphasis on teamwork, time management, follow-through, and issue resolution abilities.
• Interest in working with large amounts of data. Detail oriented and able to spot data anomalies, outliers, patterns and trends.
• Able to multi-task with multiple interruptions in a deadline-intensive environment.
• Ability to demonstrate flexibility, voicing concerns and proposing alternatives.
• Able to recognize and interpret business issues/opportunities and recommend solutions through analysis.
• Working knowledge of claim processing principals, techniques and their appropriate application.
• Strong proficiency in Microsoft Excel//Word/PowerPoint and of 3rd party claim processing tools (e.g., Imany, Model N, etc.). Knowledge of Microsoft Access a plus.
• Bachelor’s degree in business administration, marketing finance or related field. 4-5 years of experience in a utilization-based claim processing environment in the pharmaceutical or biotech industry helpful, but not required.
*Academic Level :
• Bachelor’s Degree Required in any field
Specific Responsibilities and skills for Position:
• Effectively resolve chargeback submissions timely and accurately, including the research and reconciliation of exceptions/errors. Communicate with wholesalers and end customers in the reconciliation process.
• Proactively identify potential issues and inefficiencies that arise in the areas of chargebacks, and offer recommendations and solutions.
• Load contracts (customer, products, pricing, eligibility, dates) into Gilead's contract management system and verify accuracy of all data.
• Responsible for the maintenance of contract data and eligibility to be fully compliant with contract agreements.
• Communicate new and updated contract data to wholesalers in a timely manner such that accurate pricing will be extended to eligible contract customers.
• Minimize the volume and amount of wholesaler chargeback deductions.
• Effectively collaborate with internal business teams (Government Pricing, Accounting, Finance, IT) to ensure transaction, exceptions/errors, and deductions are processed and resolved accurately and timely.
• Work with Gilead IT, systems vendors and consultants to design and implement system fixes/enhancements.
• Experience processing chargebacks in Model N or I-many contract management systems is a plus.
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