Medicaid Claims Analyst

24 hours ago

ParsippanyTroy Hills, United States Tevapharm Full time
Teva is a global pharmaceutical leader and the world's largest generic medicines producer, committed to improving health and increasing access to quality health solutions worldwide. Our employees are at the core of our success, with colleagues in over 80 countries delivering the world's largest medicine cabinet to 200 million people every day. We offer a uniquely diverse portfolio of products and solutions for patients and we've built a promising pipeline centered around our core therapeutic areas. We are continually developing patient-centric solutions and significantly growing both our generic and specialty medicines business through investment in research and development, marketing, business development and innovation. This is how we improve health and enable people to live better, healthier lives. Join us on our journey of growth The opportunity The Medicaid Claims Analyst is responsible for the Medicaid Drug Rebate process which includes validating, verifying, disputing when necessary, and remitting payment for assigned state Medicaid agencies, SPAPs and Supplemental Rebates. The Analyst is accountable for submitting payments within deadlines and in compliance with CMS guidelines and Teva rebate contract terms. This position also provides assistance in resolving dispute resolution, weekly pay run activities, SOX audits, system upgrade/implementation and ad hoc analysis. Work with assigned states to get Medicaid Summary invoice, summary data file and Claim Level Invoice each quarter and review to ensure completeness of information received. Upload data into Medicaid systems and authorize transactions. Document errors and perform research. Conduct initial quality check on summary data on all claim submissions to ensure rebate eligibility and data consistency. Perform Claim Level Detail validation. Review suspect claim records and determine if record should be disputed for payment. Resolve disputes and propose recommended amounts to be paid for historical outstanding utilization that is routinely submitted with Medicaid claims. Must have ability to work independently and make recommendations on state disputes, apply proper amounts to be paid & ensure CMS codes are applied correctly; notify states of results/findings. Complete Medicaid analyses and documentation on assigned states/programs. Communicate to manager for key findings and changes to state programs. Provide backup for Medicaid team members in any necessary functions and work with the team to establish best practices within Teva Medicaid work environment. Your experience and qualifications Position Requirements: Education Required: Bachelors degree or equivalent combination of experience, training and/or direct work-related experience. Experience Required: Prior Medicaid Claim processing experience with a Pharmaceutical and/or med Device company, state and/or state agency or as Medicaid consultant or equivalent work experience. Experience Preferred: Minimum 2 years pharmaceutical/product focused healthcare experience; Medicaid Claim processing function; manipulation of large datasets, negotiation/conflict resolution. System Implementation and report writing. Specialized or Technical Knowledge, License, Certifications needed: Knowledge of the Model N or Revitas/Flex Medicaid and/or Flex Validata system (or other comparable system) and advanced Microsoft Excel skills. Familiar with CMS Medicaid rules and state-specific issues. Up to date knowledge on Medicaid Validation rules and issues with 340B covered entities. Strong ability to organize and manipulate large volumes of data in various formats. Attention to detail and high degree of accuracy in data processing and reviews. Company/Industry Related Knowledge: Medicaid, Government Pricing and Rebate Pharmaceutical industry experience/knowledge preferred. Enjoy a more rewarding choice We offer a competitive benefits package, including Medical, Dental, Vision, and Prescription coverage starting on the first day. We also offer Disability and Life Insurance, Paid Time Off, 13 paid Holidays, 6% match on the 401(k), Employee Stock Purchase Plan, and Tuition Assistance. Tevas Equal Employment Opportunity Commitment Teva Pharmaceuticals is committed to equal opportunity in employment. It is Teva's global policy that equal employment opportunity be provided without regard to age, race, creed, color, religion, sex, disability, pregnancy, medical condition, sexual orientation, gender identity or expression, ancestry, veteran status, national or ethnic origin or any other legally recognized status entitled to protection under applicable laws. We are committed to a diverse and inclusive workplace for all. If you are contacted for a job opportunity, please advise us of any accommodations needed to support you throughout the recruitment and selection process. All accommodation information provided will be treated as confidential and used only for the purpose of providing an accessible candidate experience. J-18808-Ljbffr

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