Head of Market Access, Operations

Job Description

Vertex is hiring a Sr. Leader to join our Managed Markets team. Reporting to the Vice President, you will lead the tactical, compliant, and strategic oversight of the multi-function, Managed Markets Operations team. The team is comprised of several complimentary functions: Government Pricing and Transparency Reporting, Contract Operations, and Forecasting Analytics.

You will collaborate closely with the Managed Markets Specialty Pharmacy, Distribution and Payer Account field teams, Accounting, Compliance, Finance, Global Information Systems, Government Affairs and Public Policy, Legal, Treasury and Regulatory.

Accountable for representing the VP on internal teams, the ideal candidate will be highly attentive to detail, strategic and will possess:

• Expertise in government price calculations, programs and contracts
• Understanding of current and pending state transparency regulations
• Significant contracting expertise as demonstrated by the ability to draft terms and assess and clearly articulate potential business, Government Pricing, GTN and compliance impacts
• Experience evaluating bona fide service fees and fair market value
• Analytic mindset, skill and modeling capabilities
• Strong vendor management experience
• Executive presence demonstrated by clear and concise communication and the ability to lead and influence cross functional teams

Key Responsibilities

Government Pricing & Transparency Reporting: Serve as SME expert in the areas of FSS and CMS statutory price calculations (NFAMP, IFF, AMP, ASP, BP, CPPD), State Price and Transparency Reporting, 340B pricing and program, Coverage Gap Discount Program, and Tricare. Assess and communicate GP impact on the GTN of commercial and pipeline assets.  Review and approve all GP calculations. Ensure compliant and accurate documentation (methodologies, reasonable assumptions, memos to file, submittals to states and government agencies). As the Business Owner of Revitas, perform price and policy set-ups and oversee the business role in system upgrades and maintenance.

Contract Operations: Serve as SME on terms related to market access, data, payment terms, FMV and BFSF assessment during contract development. Support negotiations and ensure operational viability. Proactively raise business risks related to proposed contract terms. Act as business lead to Legal during drafting and redline phases of contracting. Conduct pre and post contract ROI analyses. Ensure timely FMV assessments. Review and approve US and Canadian payments. Strategize approach to and execution of disputes. Work with team to be at the forefront of the industry with regards to claims analyses, duplicate discount identification and system capabilities. Be a trusted and respected partner of states, pharmacies, distributors and payers. Oversee integrity of chargeback processes and membership management. Measure and scorecard against contracted services and reflect results in earned payment.

Identify and seek to resolve any contracted services gaps or quality issues.

Forecasting Analytics:  Oversee forecast methodology and outputs of payer mix, gross-to-net and inventory to inform monthly forecast, long range plan, and budget processes. Serve as SME on these areas at meetings with executive leadership.  Ensure accuracy of reporting, analytics and insights for the business that inform forecasting, pricing and contracting decisions and general business planning.

General: Ensure GP/Contracting SOX controls are met and supported by required documentation. Hold team accountable to compliance trainings and Vertex Code of Conduct. Be apprised of current and pending policy landscape and proactively raise potential impact to business. Own team budget and approve invoices and payments. Motivate and support team members to meet business objectives and development goals. Identify and build new, business critical capabilities across people, processes, technologies and systems.

Minimum Qualifications

• Bachelor’s degree required
• A minimum of 7 years professional experience in pharma/biotech industry/consulting environment
• Expertise in the area of government contracting and  price calculations
• Understanding of state transparency regulation
• Experience reading and writing contracts and general contract practices (payer, pharmacy, distributor experience preferred), and evaluating business impact of potential terms
• Experience with forecasting and modeling
• Strong communication and presentation skills
• Experience leading people/teams
• Understanding of commercial and government payers
• Familiarity with specialty products
• Ability to implement creative solutions to complex problems
• Dedication to cross-functional partnership and building/maintaining positive relationships across teams

Preferred Qualifications:

• Master’s degree or relevant advanced degree preferred
• Experience working with Revitas or Model N
• Previous experience supporting SOX requirements and audits
• Familiarity with chargebacks processes and membership management

Pay Range:

Disclosure Statement:

Flex Designation:

Flex Eligibility Status:

In this Hybrid-Eligible role, you can choose to be designated as: 
1.    Hybrid: work remotely up to two days per week; or select
2.    On-Site: 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.

Any applicant requiring an accommodation in connection with the hiring process and/or to perform the essential functions of the position for which the applicant has applied should make a request to the recruiter or hiring manager, or contact Talent Acquisition at ApplicationAssistance@vrtx.com