Director – Accounts & Rebate Billing

UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of two distinct and complementary businesses, UnitedHealthcare and Optum, working to build a better health system for all. Here, your contributions matter as they will help transform health care for years to come. Make an impact with a diverse team that shares your passion for helping others. Join us to start Caring. Connecting. Growing together.

About the Role:

In healthcare, evolution doesn’t just happen. It takes innovation, imagination, and a passion for solving problems in new and better ways. And innovation is taking place at a lightning-fast pace every day at Optum. 
As the fastest growing part of the UnitedHealth Group family of businesses, we’re expanding our team in Ireland and creating excellent opportunities for those who want greater purpose and more impact in their work. We’ll provide the investment, support, and resources to advance your career. You’ll provide the talent, ambition, and drive.

Nuvaila is a company that is on the rise. We are expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation is about transforming the healthcare industry. Ready to make a difference? Make yourself at home with us and start doing your best work.  
Nuvaila is seeking an experienced leader who is a detail-oriented and analytical individual to build and lead our Accounts / Billing department. The role will be based in Ireland. The ideal candidate will possess a strong background in billing, finance and / or accounting, with specific experience in the US Healthcare / Pharmaceutical industry. In this role you will be responsible for leading and building a team that verifies / validates claims data, researching disputed claims / utilization to ensure accurate and timely processing of pharmaceutical rebates including the identification of system issues, enhancements and required testing for the rebate billing system. Interprets and redlines rebate agreements prior to implementation. Rebate eligibility by client, formulary status and line of business is researched and verified with Industry Relations, Client Management, and Clinical Services prior to billing. Prepares rebate billing reports, submits invoices to pharmaceutical manufacturers, reconciles payments, resolves payment discrepancies and manages internal and external audits.

The Director – Accounts / Billing will be responsible for working cross functionally with Business / Legal / Finance / Accounting teams to fully reconcile and resolve any disputes with Pharmacy Benefit Managers (PBMs) and / or Clients, ensuring compliance with contractual and regulatory requirements to ensure that necessary payments are issued. If you are a proven leaders who is a proactive problem-solver, excels in fast-paced environments and in building strong relationships with both internal and external stakeholders, we want to hear from you.

Careers with Optum offer flexible work arrangements and individuals who live and work in the Republic of Ireland will have the opportunity to split their monthly work hours between our Dublin office and telecommuting from a home-based office in a hybrid work model. 

Primary Responsibilities:

•    Provides leadership and is accountable for the performance and direction of the Billing / Accounts department including C-suite / Executive reporting.
•    Builds & leads a team of Rebate Processing staff responsible for accurate a timely processing of pharmaceutical rebates, including 
•    preparation of rebate payment reports required by contract with rebate partners
•    submission of payment to rebate agreement partners
•    reconciliation of estimated rebates due and invoice received
•    resolution of payment discrepancies and disputes
•    manages internal and external audits
•    Rebate eligibility by client (including sub-clients of PBMs/GPOs), formulary status and line of business is researched and verified with internal stakeholders prior to payment
•    Supporting documentation is obtained from rebate submitters and reviewed to verify eligibility (Prescription Drug Lists/Formulary, Utilization Management Criteria, etc.)
•    Operationalizes agreement language (i.e. exclusions) to verify only valid rebates are paid (i.e. 340B, Aberrant claim quantities, Invalid plans, Invalid pharmacy, etc.)
•    Partners with internal stakeholders including Industry Relations, Legal, etc. to redline rebate agreements prior to implementation
•    Identification of system issues, enhancements and required testing for the rebate processing system
•    Develops and executes strategies; balances the needs of business and triages requirements to establish strategies, plans, and processes to improve profitability, cost efficiencies, and scale
•    Assesses and tracks performance of system requirements, human capital requirements and efficiency opportunities including Optum Global Advantage (OGA India), and/or third party vendor processors
•    Develops, performs, and manages analyses of business/financial metrics and performance measures
•    Develops and maintains partnership with Accounting to ensure transactions are recorded appropriately to the General Ledger
•    Develops and maintains partnership with Forecast Planning & Analysis to align, deliver and communicate business needs in all aspects of financial planning, budgeting and forecasting
•    Executive level reporting & accountability

You will be rewarded and recognised for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role, as well as providing development for other roles you may be interested in.

Required Qualifications:

•    Extensive senior level experience in building & leading billing, finance and / or accounting teams.
•    Masters & bachelor’s degree in relevant business / finance / accounting discipline and / or relevant senior leadership career experience in billing.
•    Experience in the healthcare / pharmaceutical industry, product flow and reimbursement, chargeback administration, and chargeback payment processes
•    Advanced computer skills in MS Office, particularly Excel 
•    Strong analytical and problem-solving skills
•    Effective communication and interpersonal skills
•    Ability to work productively and perform duties independently in addition to leading by example within a team environment
•    Demonstrated high degree of self-awareness, self-motivation, initiative, and attention to detail and accuracy
•    Recruitment, training & mentoring of new team members.

Preferred Qualifications:

•    Experience in the US healthcare / pharmaceutical industry
•    Lean Six Sigma qualification
•    Experience with ERP systems and data management tools such as SAP and Vistex
•    Experience working in a public company and SOX compliant organization

Please note you must currently be eligible to work and remain indefinitely without any restrictions in the country to which you are making an application. Proof will be required to support your application.

All telecommuters will be required to adhere to the UnitedHealth Group’s Telecommuter Policy.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalised groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to gender, civil status, family status, sexual orientation, disability, religion, age, race, and membership of the Traveller community, or any other characteristic protected by law. Optum is a drug-free workplace. © 2024 Optum Services (Ireland) Limited. All rights reserved.