Director, Rebates & Chargeback Operations - Vertex Pharmaceuticals

Job Description

The Director of Rebate and Chargeback Operations is a crucial leadership role, reporting into the Executive Director, Pricing, Analytics & Contract Management (PACM) team within the US Market Access organization. This is an exciting opportunity for a leader that applies an enterprise-level mindset, people management and technical expertise at the intersection of data, process optimization, automation and innovation. This individual is responsible for building a team to enable management of traditional and value-based Commercial payer rebates for US, chargebacks, Medicaid rebates, federal government payments, Canadian commercial and provincial rebates. The ideal candidate is passionate about patients, focused on driving for results, and is willing to be involved in hands-on execution while building a new function.

This role will interact with senior Commercial and Vertex leadership and the successful individual must be strategically adept, while also having a high degree of attention to detail and accuracy to mitigate revenue leakage. This leader is expected to constantly evolve and anticipate the needs and capabilities of customers, adapting to our growing portfolio, operating with compliance and integrity and contributing to Vertex’s corporate goals.

This role is a hybrid position based out of Boston, MA (2 days flexible/3 days onsite).

Key Responsibilities:

• Build, lead and motivate your team, prioritizing and allocating work across team members to ensure the highest levels of performance and commitment to their professional development
• Work with internal functions and external vendors to understand market trends and implications. Stay current with all promulgated and proposed federal regulations that impact rebate and/or chargeback adjudications
• Assess the benefits and impact of automation or implementation of digital solutions to business-critical processes which may also include recommendations on changes involving people, processes and organizational structure
• Connect and understand customers and closely partner with stakeholders (internally and externally) to develop the strategic direction of the department including people, end-to-end processes, data, and technology within budget to deliver the highest value outcomes
• Review, interpret and set-up of Canadian, US Commercial, federal and state Medicaid financial and operational contract terms in Model N/Revitas, including establishing complex calculations if supported by current systems, or alternative manual spreadsheets if not, to ensure accurate financial analysis, validation and payment as well as accurate translation into Government Price Reporting systems. Ensure timely ongoing maintenance of contract amendments and updates to maintain detailed information for audit purposes
• Timely verification of eligible members and/or plans and validation of customer policies to confirm rebate and chargeback eligibility. Also includes interpretation of medical policies, formularies, prior authorizations, benefit plans, reimbursements and pathways for Vertex products and competitors, where applicable
• Research, review, and interpret complex data to evaluate performance criteria on a unit by unit and customer by customer basis. Perform complex financial analytics to further execute and validate rebate calculations to ensure accuracy
• Respond to, research and address customer disputes within contractual timeframes to ensure obligations are met. Provide timely issue resolution that impacts multiple customer segments. Accurately and concisely deliver customer-centric communication in response to disputes and ensure compliance with the eligibility terms
• Lead training efforts and development of departmental standard operating procedures (SOPs) that reduces process variation and drives process flexibility, efficiency and effectiveness
• Work with Contract Operations and Govt Pricing teams to ensure compliance with Fair Market Value and Bona Fide Service Fees in agreements
• Lead monthly and quarterly reporting of contractual payment activities, dashboards and trends, support forecasting analyses and ad-hoc requests
• Work collaboratively with stakeholders including but not limited to: Government Pricing & Programs, Contract Operations, GTN Forecasting, USMA Analytics COE, Data & Technology Enablement (DTE), Public Affairs, Commercial Legal, Payer Accounts, Trade & Distribution FP&A, Accounting, Internal Audit etc. to ensure transparency and collaboration across key processes and decisions. Support for these activities will vary and may include ownership of parts of the process.
• Ensure all SOX controls are met and supported with appropriate documentation. Participate in and support SOX-related, internal and external audits

Minimum Qualifications:

• Bachelor’s degree in a quantitative or technological discipline required (e.g., Engineering, Computer Science, Accounting, Statistics, Economics, Finance)
• 10+ years US pharmaceutical industry-adjacent experience with increasing responsibilities, including experience in rebate and chargeback validation, processing, and payments to Medicare, Medicaid, FSS, commercial payers, GPOs and IDNs
• 7+ years of leadership experience in managed care and related technology-centric knowledge
• Excellent understanding of Managed Care Agreements, Rebates, Chargebacks and State Medicaid rebate processes
• Proven effectiveness as a creative problem-solver, strong analytical thinker and decision-maker
• Thorough working knowledge of Government Pricing calculations, Medicaid and Medicare, FSS, the evolving US Pricing & Reimbursement dynamics and health system environment for retail, specialty, rare and transformative therapies
• High level of proficiency in pharmaceutical rebate and chargeback systems, Excel, PowerPoint and Word
• Demonstrates an executive presence, strong business acumen, strong passion for innovation, ability to navigate ambiguity, and manages complexity
• Focus on continuous delivery through collaboration, and bringing people together to work towards the same purpose across organizational boundaries
• Exhibits intellectual curiosity, an entrepreneurship attitude, integrity, ability to mobilize and empower teams and individuals to act autonomously holding them accountable for results
• Effective communicator, someone who can inspire and energize people with ideas and ability to influence decision-makers through incisive analysis and persuasive communication

Preferred Qualifications:

• MBA, MPH or a Master’s in a quantitative discipline
• 10+ years in biotech/pharmaceuticals in a quantitative role in Managed Markets / Commercial / Finance / Investment Banking, or 5+ years in biopharma consulting (management, strategic or economic consulting) post-MBA/PhD, with meaningful biotech/pharmaceuticals with direct reports and quantitative decision support experience
• US product launch experience, including cell and gene therapies
• Contract strategy implementation experience
• Value based contract implementation experience highly preferred
• Experience in working with senior leadership to support financial forecasting and analytics, and/or commercial launch planning
• Knowledge of AI/ML tools, query languages/tools (SQL, Alteryx) and data visualization tools

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Flex Designation:

Hybrid-Eligible Or On-Site Eligible

Flex Eligibility Status:

In this Hybrid-Eligible role, you can choose to be designated as:

work remotely up to two days per week;

work five days per week on-site with ad hoc flexibility.

Note: The Flex status for this position is subject to Vertex’s Policy on Flex @ Vertex Program and may be changed at any time.

Company Information

Vertex is a global biotechnology company that invests in scientific innovation.

Vertex is committed to equal employment opportunity and non-discrimination for all employees and qualified applicants without regard to a person's race, color, sex, gender identity or expression, age, religion, national origin, ancestry, ethnicity, disability, veteran status, genetic information, sexual orientation, marital status, or any characteristic protected under applicable law. Vertex is an E-Verify Employer in the United States. Vertex will make reasonable accommodations for qualified individuals with known disabilities, in accordance with applicable law.