Job Summary:
The Rebate Operations Manager will lead the end-to-end data lifecycle of our rebate programs. This role is responsible for the technical accuracy of claims submissions, the validation of payments against contract rates, and the recovery of "stale" or missed billing opportunities. You will serve as the primary link between our internal data and external partners, ensuring that our rebate revenue is captured fully and accurately at the NDC-11 level.
What you will do:
Claims Lifecycle & Quality Assurance
- Submission Management: Oversee initial claims file submissions and conduct comprehensive QA summaries to identify potential fallouts before submission.
- Error Resolution: Manage rejections from external partners; perform root-cause analysis on data issues and re-submit corrected claims to maximize capture.
- Stale Billing Recovery: Monitor and "push" for the billing of claims missed during initial windows due to vendor delays or data gaps, ensuring no revenue is left on the table.
Financial Integrity & Rate Maintenance
- Rate List Development: Build and maintain master rate lists based on current formularies and utilization management (UM) to correspond with product-specific rates.
- Invoice Verification: Marry billed amounts back to rate lists to identify missing, incorrect, or inappropriately billed amounts.
- Payment Reconciliation: Verify incoming payments against invoiced amounts; identify and dispute short-payments or missing funds.
Advanced Analytics & Forecasting
- Detailed Reporting: Build out rebate performance reports.
- Financial Estimating: Run monthly "pro-forma" estimates of expected rebates to serve as a benchmark for actual collections.
- Visual Data Strategy: Manage and optimize the internal dashboards to provide "slice-and-dice" visibility into rebate trends for executive leadership and sales teams.
What you will bring to SmithRx:
- Bachelor’s Degree: Finance, Accounting, Data Analytics, Economics, or Business Administration.
- Minimum of 2 years of direct experience with a GPO or similar rebate aggregators/aggregating platforms is highly preferred.
- Proficiency in managing large data sets at the NDC-11 level. Advanced Excel is required.
- Strong understanding of the "reconciliation loop" connecting initial claims to invoices, and invoices to actual cash received
- A proven ability to track "Stale Billing" and "Post-Billing Rejects" through to resolution.
- Proven knowledge of pharmacy benefit management practices, including UM and clinical program design.