Manager, Medicaid Claims
AbbVie’s mission is to discover and deliver innovative medicines that solve serious health issues today and address the medical challenges of tomorrow. We strive to have a remarkable impact on people’s lives across several key therapeutic areas: immunology, oncology, neuroscience, eye care, virology, women’s health and gastroenterology, in addition to products and services across its Allergan Aesthetics portfolio. For more information about AbbVie, please visit us at www.abbvie.com. Follow @abbvie on Twitter, Facebook, Instagram, YouTube and LinkedIn.
Primary Job Function:
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 three 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 $3 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 and provide Corporate Treasury weekly payment forecasts during heavy processing periods. 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.
5+ 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 is helpful.
Significant Work Activities
Continuous sitting for prolonged periods (more than 2 consecutive hours in an 8 hour day)
Yes, 5 % of the Time
Job Level Code
Equal Employment Opportunity
At AbbVie, we value bringing together individuals from diverse backgrounds to develop new and innovative solutions for patients. As an equal opportunity employer we do not discriminate on the basis 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, protected veteran status, or any other legally protected characteristic.