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Financial Analyst

3 months ago

ParsippanyTroy Hills, United States Brooksource Full time

Managed Care Rebate Analyst/Consultant

Hybrid, Parsippany, NJ


The Managed Care Rebate Analyst/Consultant is responsible for the processing of Managed Care Commercial, Medicare Part D, Managed Medicaid, and Medical Agreement rebate claims in accordance with the terms and conditions of the rebate contract and internal processing procedures. This position is responsible for analyzing utilization data, applying rules to determine included and excluded claims, assigning appropriate rebate percentages to utilization claims, and initiating payment to customers within contractual guidelines.


• Must have a thorough understanding of PBM networks, drug formularies, and all Managed Care rebate and fee types, including Base Rebates, Administrative Fees, Price Inflation Rebates

• Interpret contract language; input/maintain plans, products, and reimbursement thresholds in the Model N/Flex System

• Analyzes utilization data for completeness and accuracy

• Applies appropriate validations to utilization data; exclude ineligible claims (duplicates, ineligible pharmacies, aberrant quantities)

• Processes rebates through Model N/Flex Revenue Manager Submissions, Adjudications and Settlement Modules, resolving all errors and rejecting lines where appropriate

• Ensures calculated reimbursements are approved at all levels and prepared for payment

• Tracks invoice and calculation amounts; analyzes and explains large variances period over period and invoice vs. calculated amounts

• Assists with system testing as needed

• Maintains and communicates payment calculation details and rejected claim explanation to management and/or customer

Experience and qualifications

• Must have extensive experience with Model N/Flex – Validata and Revenue Manager modules; Validating utilization data from PBMs, Managed Care Contract maintenance, and Managed Care Rebate Processing

• Intermediate Excel Level – extensive experience with pivot tables, vlookups

• Exemplary Analytical skills

  • • Strong Communication skills