DIRECTOR, GOVERNMENT REPORTING

Job Summary

Ownership of all aspects of Government Contracts, and Price Reporting, including, but not limited to the direction of lower management levels in the day-to-day pricing system operations; calculation and reporting compliance requirements; training development and delivery; testing and monitoring; external audits (e.g., Office of Inspector General); records retention; government rebates, membership analysis, and data integrity. Management of Government Pricing, Medicaid Rebates, and Government Contract departments and personnel. Role is critical to ensuring compliance with Government Pricing Compliance and Contracting standards. As the regulatory landscape is rapidly changing, this position will require the ongoing analysis of new government regulations as they relate to reporting obligations. This individual will be encouraged to identify opportunities for process improvements and efficiencies.

Responsibilities

• Responsible for pricing decisions that have a serious regulatory and legal impact on the overall success or failure for reporting requirements. Erroneous decisions or recommendations may lead to government investigation or cause for litigation causing substantial expenditure of time, human resources, and funds.
• Responsible for adherence to the Medicaid Drug Rebate Program, compliance with State Drug Pricing Transparency Programs, Opioid tax legislation, and various State reporting requirements
• Primary company contact for government agencies including, but not limited to: Centers of Medicare and Medicaid (“CMS”), Health Resources and Services Administration (“HRSA”), and Veteran’s Administration (“VA”), and state health departments.
• Lead for responding to government inquiries, investigations and audits.
• Provide input to update and, as new regulations are proposed, assist in the creation of new policies and procedures to reflect these changes and/or provide relevant comments to assist in the Government Affairs and Legal departments.
• Direct and control the activities of a broad functional area through several department managers. Has overall control of planning, staffing, budgeting, managing expense priorities, and recommending and implementing changes to methods and oversight of Consultants/Vendors used for projects.
• Regularly interact with senior management and participate in the commercial Pricing Committee. Conduct business and technical briefings for senior and top management and for external representatives, providing insight into impacts of pricing approaches.
• Establish policies for all Government Pricing areas including procedures, calculations, and reports for all products to ensure that they are current, accurate, and complete and submitted on time and in compliance with all program requirements. Interprets and recommends modifications to company-wide policies and practices in all department that may impact the Government Pricing area.
  • Medicaid Drug Rebate Program
  • Public Health Service 340B Pricing Program (“340B”)
  • Medicare Average Sales Price (“ASP”)
  • Veterans Health Care Act of 1992 (“VHCA”)
  • State Drug Pricing Transparency
• Review all Government Pricing calculations and reporting processes. Support analyses of variances in price reporting, including presentation to approver(s) (CCO and CFO) prior to reporting and certification.
• Responsible for review and approval of calculations of risk assessments and exposure calculations pertaining to Government Reporting statutes; validates and approves quarterly accrual calculations to support Financial reporting
• Ensure the Company’s accurate and timely submissions for all government Rebate processing requirements, including, but not limited to:
  • Medicaid State rebates
  • State Supplemental rebates
  • HRSA rebates, such as ADAP, etc.
  • TRICARE rebates
  • Medicaid Managed Care
  • Medicare Coverage Gap Discount
  • Annual IRS Branded Tax
  • Opioid Tax
• Participate with appropriate stakeholders to establish strategic plans and objectives. Make final decisions on administrative or operational matters and ensures operations are efficient and effective, as well as confirming the achievement of company objectives.
• Provide leadership on proposed commercial initiatives and tactics, identifies moderate to complex compliance issues, conducts analysis and proposes compliant alternatives. Facilitate discussions and interactions between Chargebacks, Credits and Collections, Contract Marketing and government pricing.
• Evaluate new and modified payer, government, and commercial contracting proposals, perform risk assessments, adhere to operational processes and SOPs, and recommend business improvement initiatives where appropriate.
• Participate on cross-functional teams as a subject matter expert representing the Government Pricing and Contract Management as required to evaluate and implement business strategies and initiatives.
• Serve as a liaison with Commercial Leadership, Customer Service, Brand and Accounting/ Finance teams regarding a variety of issues impacting government pricing.
• Present findings to executive management for assessment and consideration, to support strategy and decision making
• Participate in industry conferences and obtain specialized training as necessary to stay current with all laws, regulations, and requirements related to all Government Pricing programs
• Will be responsible for identifying and implementing efficiencies throughout functional areas
• Business lead/liaison with IT on system design and strategy to meet business needs and expanding portfolio
• Investigate Government pricing trends and cross channel impact.
• Possesses in-depth knowledge of internal clients supported and knowledge of the broader business impact. Leads cross-functional teams on projects.
• Responsible to manage and limit risk exposure, working closely with Legal department to ensure appropriate legal risk management
• Adhere to all records retention requirements
• Will have direct report(s) and associated people management responsibility, with focus on mentoring, coaching, and developing direct report(s) and others
• Strong teamwork and interpersonal skills a must.
• Responsible for recruiting and hiring team members.

Requirements

• Must have a bachelor’s degree from an accredited institution; post-graduate degree is preferred
• Minimum of 12 years’ work experience in Government Pricing area, with at least 5 years in a management capacity
• Must demonstrate knowledge and understanding of U.S. pharmaceutical compliance issues, including system requirements.
• Experience with Model N implementation preferred
• The candidate should be a strategic-thinking leader and a natural team player who has demonstrated their capacity to succeed in collaborative work scenarios
• Ability to self-start and self-direct work in a fast-paced environment.
• Excellent project management skills. Ability to prioritize and work simultaneously on multiple projects, strong attention to detail, and ability to organize/analyze complex information and data.
• Excellent written and verbal executive-level communication skills.
• Adaptability necessary to work effectively in a changing regulatory environment.
• Ability to demonstrate sound and independent judgment, prudence and maturity in complex and sensitive cases.
• Client orientation with a constructive approach to resolution of issues. A style which builds alliances within the organization and with corporate collaborators.
• Strong analytical, organizational, problem solving, and follow-up skills. Ability to interpret rules and guidelines and synthesize with current business objectives to provide guidance.

Additional Information

We offer an excellent salary and benefits package including medical, dental and vision coverage, as well as life insurance, disability, 401K with company match, and wellness program.

Fresenius Kabi is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disabilities, or protected veteran status.