Manager, Medicaid Claims

Job Description

The US federal and state governments are significant customers of AbbVie ensuring patients covered under their numerous healthcare programs have access to our medicines.

Medicaid is one of the largest of these programs. AbbVie contributes to the success of this program by providing discounted prices on our products.

The incumbent will manage the analysis, payments, and disputes of a large volume of quarterly rebate claims within required timelines.

Core Job Responsibilities :

• Manage and develop five or more direct reports in the payment of rebate claims.
• Offer guidance on the analysis of payments for reasonableness as well as on dispute guidelines.
• Act as a liaison between AbbVie and government customers to drive the team to the settlement of disputes.
• Perform ad hoc legal, management, and customer requests.
• Maintain procedural documentation as required by changes in legislation and business practices.
• Assist various projects related to government system upgrades and / or enhancements.
• Perform other duties as assigned.

Position Accountability and Scope :

Ability to manage a team and perform duties independently or with a low level of supervision. The incumbent is responsible for the accurate and timely payment of Medicaid rebates totaling $7 billion annually to state Medicaid agencies, including providing adequate review and approval of payments as they are processed by team members.

Must have the aptitude to understand and analyze payment trends and ensure team members have accurately depicted and explained payment variances from prior periods, including managing and forecasting the right level of balance sheet reserves.

Must support corporate cash flow management activities by ensuring payment releases as close to the due date as possible.

Incumbent will ensure team members are current with resolving invoice disputes to keep balances within reasonable levels, including ensuring periodic payment reconciliations with the states as required.

Must build strong product knowledge in order to perform the necessary units per script and reimbursement test validations to ensure payment accuracy for key products.

Must have a strong technical background to support the various Excel reports and tools required to manage the business, including quickly learning the Medicaid modules in the Model N Revenue Management System.

A background in SQL / VBA programming is preferred. Must have the ability to manage multiple priorities, ad-hoc projects, and react to a rapidly changing dynamic work environment.

He / she is expected to identify opportunities for productivity and process improvements.

Qualifications

Minimum Education :

BA / BS required;

7+ years business experience, preferably with a concentration in contracting, Medicaid related activities or financial analysis

Minimum Experience / Training Required :

Incumbent must have the ability to manage a productive team tasked with demands that require responding to a high volume of work that requires absolute accuracy and rapid turnaround time.

Must have excellent oral and written communication skills as job responsibilities include communicating with various levels of management within AbbVie as well as with external customers.

The job can be demanding at times due to the dynamic nature of the rebate function and the evolving legislative and legal environment.

Therefore, it requires ability to respond to change and to continually reprioritize to satisfy demands of a rapidly changing environment.

Problem solving and integrity are key competencies of this position. Must be able to drive the process and ensure sound judgment in determining appropriate payments.

Extremely strong organizational skills along with a high degree of follow through are requirements. Must have intermediate or higher-level skills with the Microsoft Office Suite, especially Excel.

Previous experience with Revenue Management software (i.e., Model N, Revitas, etc.) and SQL / VBA, Power BI is helpful.

Additional Information

Applicable only to applicants applying to a position in any location with pay disclosure requirements under state or local law :

The compensation range described below is the range of possible base pay compensation that the Company believes in good faith it will pay for this role at the time of this posting based on the job grade for this position.

Individual compensation paid within this range will depend on many factors including geographic location, and we may ultimately pay more or less than the posted range.

This range may be modified in the future.

We offer a comprehensive package of benefits including paid time off (vacation, holidays, sick), medical / dental / vision insurance and 401(k) to eligible employees.

This job is eligible to participate in our short-term incentive programs.

This job is eligible to participate in our long-term incentive programs

Note : No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, incentive, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole and absolute discretion unless and until paid and may be modified at the Company’s sole and absolute discretion, consistent with applicable law.

AbbVie is an equal opportunity employer and is committed to operating with integrity, driving innovation, transforming lives, serving our community and embracing diversity and inclusion.

It is AbbVie’s policy to employ qualified persons of the greatest ability without discrimination against any employee or applicant for employment because of race, color, religion, national origin, age, sex (including pregnancy), physical or mental disability, medical condition, genetic information, gender identity or expression, sexual orientation, marital status, status as a protected veteran, or any other legally protected group status.

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US & Puerto Rico applicants seeking a reasonable accommodation, click here to learn more :

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