Director – Rebate Contract Operations

Responsibilities

• Data flow between Lumicera Contracts team and other internal stakeholders like finance, analytics, sales, and account management.
• Data flow between Lumicera, GPO and Pharma and/or other vendors including submission of claims data.
• Work with IT to prioritize and deliver on solutions enabling all data flow needs.
• Account Reconciliation file receipt, analysis, and furnishing the necessary data so finance can invoice clients.
• Complete audits.
• Implementation of New Clients which involves evaluation of formulary from a roll up standpoint.
• Prospective Reporting including forecasting/projecting rates based on existing data, making assumptions and documenting such assumptions/caveats in calculating forecasted rates using existing data.
• Creating a potential bid grid based on known data components, again making and documenting assumptions.
• Constantly comparing actuals vs. forecasted to finetune assumptions.
• Forecasting guarantees based on rates, utilization and other factors like inflation.
• Retrospective Reporting to ensure all client reports are generated timely and accurately.
• Analyzing the data to ensure clients are receiving maximum contract value.
• If there are gaps, identify the reasons for those gaps and work with key stakeholders to correct those.
• Contract Optimization to analyze client formulary against best formulary placement with pharma and GPO to then supply the data/information that would be needed by our contractors to have meaningful conversations with pharma and GPO and our clients in order to maximize client contracts while still maintaining our lowest net cost philosophy.
• Ensure that RFPs are responded to in a timely and accurate manner.
• Ensure that guarantees are developed using appropriate methodology, wherein risk is accounted.
• Ensure absolute alignment with Implementations and Sales so the conditions associated with a guarantee are met.
• Understand client and regulatory requirements around the service.
• Operationalize the service working closely with other operational areas like formulary and Claim adjudication to ensure accuracy of the setup.
• Work closely with vendors or strategic partners to make sure the relationship is a mutually successful partnership including aligning strategic priorities with the partner and tracking performance of vendors against guarantees, tracking the dispute resolution process, and creating dashboards that capture current state in a comprehensive manner.
• Other duties as assigned.

Requirements

• Bachelor’s degree or equivalent work experience required.
• 2 years in a PBM, GPO or equivalent setting required.
• Proven experience in designing an operation, building processes, and scaling and automation required.
• Proven track record of process improvement/system enhancements required.
• Experience with tools/systems around automation of processes preferred.
• Proven track record of collaboration with multiple stakeholders, internal and external, required.
• Leadership experience required.
• Experience in working with Senior Leadership within an organization required.
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

Core Competencies

Demonstrates expertise in data flow management, contract optimization, and operational processes within a PBM or GPO environment. Proven ability to collaborate with stakeholders, implement process improvements, and ensure compliance with regulatory requirements.