Teva Sr Contract Compliance Analyst III 

United States, New Jersey 

109896852

Reporting to the Sr. Director – Contract Compliance, the incumbent will be responsible for identifying and investigating formulary positions on PBM and Health Plan websites and formal Pharmacy Drug Lists (PDL) to validate product placement complies with all terms and conditions of the managed care contract. Using critical thinking skills and data analytics, the incumbent will complete complex investigational audit reviews, identify risks and compliance issues and present findings both verbally and in writing to key internal and external stakeholders. In addition, the Sr. Contract Compliance Analyst will participate in identifying and recommending contracting strategy changes as it relates to the effectiveness of the contract terms and conditions.

The Sr. Contract Compliance Analyst reports to Sr. Director Contract Compliance within the Revenue Optimization and Contract Compliance group. (ROCC).

Major duties and responsibilities required to achieve the position’s objectives and be successful in the Sr. Contract Compliance Analyst role:

• Establishes audit plan to review top 80% of contracted account formularies across commercial, Medicare Part D, and managed Medicaid channels.
• Reviews Teva products on each formulary and assesses compliance within stated terms and conditions of contract. Requests and obtains supporting documentation (prior authorizations, step edits, etc.) as need to complete assessment.
• Maintains system to identify and track the status of all disputed records within each account and channel. Reports compliance savings.
• Analyzes claim data to identify formulary outliers and to assess financial impact of formulary noncompliance
• Completes formulary assessment documents for Compliance Committee review. Supports their compliance assessment.

Education: Bachelor’s Degree Required, MBA Preferred

Experience Required:
• Minimum 2-3 years’ experience working in a Pharmacy Technician role
• Thorough understanding of Managed Care contracting as it relates to formulary access and tier position; Industry understanding of step-edits, NDC blocks, prior authorizations, copay differentials, preferred and non-preferred status is a plus.
• Ability to articulate comprehensive understanding of contract terms and conditions
• Advanced understanding of pharmaceutical rebate flow and decision points
• Minimum 5-7 years’ experience in financial analysis.
• Minimum 2-3 years’ experience working with drug formularies
• Advanced Excel skills

Preferred Experience:
• Brand pharmaceutical business, specifically in market access
• Negotiation and presentation skills
• Understanding of drug purchase discounts and interaction with Rx based rebates

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