Director – Pricing and Contracting

Director – Pricing and Contracting

Requirements

• Bachelor’s degree Required.
• Master’s degree in accounting, finance, business administration or data analytics preferred
• 7+ years’ experience of Market Access contracting, pricing, contract administration, and contract compliance
• Excellent Project Management skills with demonstrated history of implementing large scale projects, and transitions
• Zero-to-One experience of building teams, internal and external stakeholder partnerships, comprehensive processes, and knowledge of industry best practices
• Ability to work on site Monday, Tuesday & Thursday. We are unable to consider candidates who are looking for fully remote roles.

Responsibilities

• Lead Axsome’s Contract Operations function, leading appropriate execution of terms and conditions for Managed Care Rebates, Medicaid, 340B, FSS/VA contracts, etc.
• Lead Axsome’s Government Pricing Compliance efforts, collaborating with internal team members and external service providers. Ensure accuracy and timely completion of reported prices (AMP, BP, PHS, NFAMP, etc.)
• Ensure appropriate execution of approved and finalized payer/PBM contracts, including working with internal and external partners to validate adjudicated rebates, fees, price protection, and other price concessions
• Establish internal processes for Contract Compliance by working collaboratively across the organization
• Establish audit plan to review top contracted formularies across Commercial, Medicare Part D and Managed Medicaid segments
• Partner with Trade and Distribution function to establish and implement 340B rebate compliance strategy across distribution/payer/PBM customer segments
• Assess and implement oversight over revenue leakage risk through contracting and contract compliance efforts, including duplicate discount and chargeback mitigation, rebate non-compliance, price calculation and reporting, and other areas of gross-to-net risk
• Lead Government Channel contracting strategy across VA, DoD, PHS, Medicaid, and Medicare segments
• Act as subject matter expert and fulfill all Federal and State Reporting requirements for Axsome, including but not limited to AMP, URA, PHS Ceiling Price, NFAMP, FCP, BP, WAC changes, etc
• Act as subject matter expert and lead accurate and appropriate implementation of Government Pricing Calculations, Reporting obligations, Class of Trade Schema determination, Federal & State reporting requirements, Chargeback and Rebate Processing, Government Claims Processing, and Managed Care Rebate Processing
• Lead Government Price (GP) Reporting vendors and ensuring processes and procedures are well-documented
• Collaborate with Finance to develop, inform and maintain Gross-to-Net calculations, forecasts, and reviews with internal and external stakeholders
• Keep abreast of industry updates; provide pertinent updates to the broader team through weekly newsletter and monthly regulatory meetings
• Participate in CMS/government agency calls related to policy updates such as the IRA implementation, Medicare rule-making updates, etc.
• Provide feedback/information related to business impacts of policy/regulation changes, pending lawsuits, pending legislation, etc. to company at large through formal summits, informal lunch & learns, etc.
• Review regulation/legislation impact to industry/product line (e.g., mental health parity regulations/comments on regulations, state mental health exemptions, etc.)
• Stay up to date on Medicaid landscape (e.g., FFS, state PDLs, carve-outs, etc.)
• Stay up to date on Medicare landscape (e.g. Benefit designs, patient co-pay smooth up-take, etc.)
• Work with Legal to update internal policies to reflect changes to regulations, legislation, etc.
• Provide data analysis related to impacts of pending/passed legislation and/or regulations (e.g. estimated financial liability due to Part D inflation penalty, operational costs of implementing new policies/programs, etc.)

Preferred Qualifications

• Master’s degree in accounting, finance, business administration or data analytics preferred
• Prior experience in Managed Care Rebate processing, GP reporting and methodologies, claim adjudication highly preferred