Manager of Chargeback Operations

Vertex Inc. • Boston, MA

43d • Remote

About The Position

The Manager of Chargeback Operations is a critical role, reporting to the Associate Director, Chargeback Operations. This role is in the Market Access Contract Operations (MACO) 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 membership management as we expand into new disease areas, operating with compliance and integrity and contributing to Vertex’s corporate goals. This is a remote role.

Requirements

• Bachelor’s degree in business 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, membership management, processing, and payments to FSS, Wholesalers, GPOs and IDNs.
• 5+ years’ experience with managed care contract admin technology (i.e. Model N, EDI, GPO’s).
• Experience with GPO rosters and internal discount programs.
• Working knowledge of the 340B program and government regulations.
• 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.

Nice To Haves

• 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.

Responsibilities

• Play a critical role in managing membership for 340B, GPOs and additional strategies in multiple therapeutic areas, 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, Contract Operations, Payer Accounts and Legal, etc. to provide key insights during contracting strategy design, contract development, negotiation, and operationalizing strategies.
• 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 membership management process, ensuring accuracy and compliance with industry regulations and internal SOX controls.
• Lead for SOX-related, internal, and external audits.
• Knowledge and understanding of the 340B Drug Discount Program and membership eligibility requirements to safeguard against diversion, duplicate discounts, and incorrect chargebacks submissions.
• Support internal assessments of contract pharmacy arrangements in alignment with 340B Contract Pharmacy Policy terms and conditions
• Analyze purchase data and investigate chargeback anomalies related to eligibility, NDCs, contract pharmacies, and/or potential duplicate discounts
• Responsible for contract operationalization, 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 and membership 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.
• Experience validating chargebacks, monitoring program utilization and assisting with compliance and contract management.
• Determine Classes of Trade based on eligibility rules and assess the compliance of programs.

Benefits

• This role is eligible for an annual bonus and annual equity awards.
• Some roles may also be eligible for overtime pay, in accordance with federal and state requirements.
• At Vertex, our Total Rewards offerings also include inclusive market-leading benefits to meet our employees wherever they are in their career, financial, family and wellbeing journey while providing flexibility and resources to support their growth and aspirations. From medical, dental and vision benefits to generous paid time off (including a week-long company shutdown in the Summer and the Winter), educational assistance programs including student loan repayment, a generous commuting subsidy, matching charitable donations, 401(k) and so much more.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 1,001-5,000 employees