Medicaid Rebates Analyst

3 days ago

ParsippanyTroy Hills, United States Collabera Full time

The Medicaid Claims Analyst is responsible for overseeing the Medicaid Drug Rebate process, including validating, verifying, disputing when necessary, and remitting payments to assigned state Medicaid agencies, State Pharmaceutical Assistance Programs (SPAPs), and for Supplemental Rebates. The Analyst ensures payments are submitted within the required deadlines, in compliance with CMS guidelines, and according to Teva rebate contract terms. This role also supports dispute resolution, SOX audits, system upgrades, and ad-hoc analysis.

Key Responsibilities:

Medicaid Invoice and Claim Processing (40%)

  • Work with assigned states to receive Medicaid Summary Invoices, data files, and Claim Level Invoices quarterly.
  • Review completeness of information and upload into Medicaid systems.
  • Conduct quality checks on submissions to ensure rebate eligibility and data consistency.
  • Perform Claim Level Detail validation to identify records that should be disputed for payment.

Dispute Resolution (25%)

  • Resolve disputes on historical outstanding claims.
  • Independently recommend payment amounts and ensure correct CMS codes are applied.
  • Communicate results and findings to states, proposing resolutions based on established policies.

Compliance and Documentation (20%)

  • Conduct Medicaid analyses and prepare documentation on assigned states/programs.
  • Communicate key findings to management and document changes in state programs.

Team Collaboration and Support (10%)

  • Provide backup to other Medicaid team members and contribute to establishing best practices within the work environment.
  • Participate in ongoing training and stay updated on Medicaid rules, state-specific issues, and regulatory changes.

Ad-Hoc Responsibilities (5%)

  • Assist with weekly payment run activities, SOX audits, system upgrades, and other ad-hoc projects as assigned.
  • Prepare and present reports as necessary for internal stakeholders.


Position Requirements:

Education:

  • Bachelor’s degree or an equivalent combination of experience, training, and work-related background.


Experience:

Required:

  • Minimum 2+ years of pharmaceutical or healthcare experience focusing on Medicaid claim processing.
  • Prior Medicaid Claims experience in a pharmaceutical company, state agency, or as a Medicaid consultant.

Preferred:

  • Experience working with large datasets, conflict resolution, system implementation, and report writing in a Medicaid or government pricing context.


Technical Skills:

  • Strong proficiency in Medicaid rebate systems, specifically Revitas/Flex Medicaid, Model N, or other comparable systems.
  • Advanced proficiency in Microsoft Excel (e.g., pivot tables, v-lookups, data manipulation).
  • Strong knowledge of CMS Medicaid rules and state-specific issues, including 340B covered entities.

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