Government Programs Manager

See Yourself at Telix

The Government Program Manager will be relied upon for price reporting obligations for programs administered by Centers for Medicare and Medicaid Services (CMS) and the associated contractual obligations. As a member of the Market Access Team, the GPM will perform government pricing calculation activities, including transactional data analysis, calculation execution, documentation, and submission of pricing to the various agencies. The GPM will work to ensure the accuracy and quality of calculations through the ongoing development of the vendor systems integration, as well as support the expansion of our systems for future product calculations and reporting requirements. The GPM will also maintain accurate and up-to-date policies and procedures related to Government Pricing and will partner with the VP and Director, Market Access, to provide critical insights to rebate operations, and support expansion of processes as Telix expands into new therapeutic areas.

Key Accountabilities:

• Expanded knowledge and experience in government pricing calculations and reporting including Medicaid, Medicare, and VA/DOD programs.
• Reports monthly and quarterly pricing obligations to CMS, including source data reconciliation, calculation, documentation, and pricing submission.
• Collaborates with cross-functional teams and outside vendors to understand and resolve reconciliation and data issues quickly.
• Provides the dissemination of data and accuracy of calculations to vendor partners.
• Works with cross-functional business partners on forecast and accrual estimates, modeling, and analysis.
• Will develop actionable and tactical recommendations that enable Telix to adapt processes and systems from evolving changes in U.S. government payer practices, policies, relevant legislation, regulations, trends and other dynamics.
• Establishes and maintains policies, procedures, and standards in support internal/external financial reporting processes, and government regulations and stays abreast of CMS Medicaid rules and guidance changes, Medicare and VA/DOD rules and guidance requirements.
• Completes special projects.
• Works closely with internal stakeholders to build the infrastructure and tools to support pricing calculations.
• Performs the reconciliation of third party and internal transactional data including sales, chargebacks, credits, rebates, fees, and other applicable discounts.
• Collaborates with Rebate Operations, Trade and Distribution, Trade Account Managers, Third Party Logistics providers, and Accounting for timely resolution of any data processing errors, reconciling items and/or adjustments.
• Coordinates resolution of data scrubs and/or validations.
• Assesses data adjustments to government pricing data.
• Maintains detailed support for all required data modifications. 

Education and Experience Requirements:

• A bachelor’s degree in business, Finance, Accounting or Public Policy, and/or equivalent working experience.
• 7+ years of experience in pharmaceutical/biotechnology industry or state agency, with experience in Government Pricing, Accounting/Finance, or other related government payer/program administration experience.
• Experience with effective management of large datasets and data query tools.
• Must demonstrate a high level of proficiency with Microsoft Access, Excel, PowerPoint and Word.
• Ability to manage peak calculation cycle workloads and documentation activities.
• Strong knowledge/understanding of drug contracting, government and commercial customers, and the distribution channels.
• Demonstrable knowledge of the current policies and guidelines that affect government programs, pricing and payment adjustments

Key Capabilities:

• Comfortable supporting and collaborating in a fast-paced environment through teamwork and open communication.
• Executes with a level of high personal accountability to meet mandatory reporting timelines and special project timelines.
• Ability to prioritize and focus on activities that drive value and increase operational effectiveness.
• Strong verbal and written communication skills, time management, and organization.
• Applies experience, structured thinking, emerging knowledge, and trends to help solve problems logically.

• Commitment to excellence:
  • Take pride in your work and consistently strive for excellence in everything you do
• Results-oriented:
  • Driven to achieve goals and objectives, with a strong focus on delivering measurable results
• Creativity and innovation:
  • Possess a willingness to think outside the box and come up with unique and creative solutions to challenges
• Strong communication skills:
  • Able to communicate effectively with colleagues and stakeholders at all levels, using clear and concise language
• Collaboration:
  • Work effectively as part of a team, actively sharing knowledge and expertise to achieve common goals
• Resilience:
  • Demonstrate the ability to bounce back from setbacks and persevere in the face of challenges
• Inclusive mindset:
  • Demonstrate an understanding and appreciation for diversity, and actively work to create an inclusive environment where everyone feels valued and respected
• Adaptability:
  • Comfortable working in a dynamic environment, able to adjust to changing priorities, and willing to take on new challenges
• Ethical behavior:
  • Act with integrity and demonstrate a commitment to ethical behavior in all interactions with colleagues and stakeholders
• Continuous learning:
  • Show a commitment to ongoing learning and professional development, continually seeking out opportunities to expand your knowledge and skills