Medicaid Claims Specialist
4 hours ago
Teva Pharmaceuticals is a global leader in the pharmaceutical industry, dedicated to improving health and increasing access to quality health solutions worldwide.
Our company is committed to innovation, with a diverse portfolio of products and solutions for patients. We strive to deliver the world's largest medicine cabinet to 200 million people every day.
The OpportunityThe Medicaid Claims Analyst is a critical role in our company, responsible for the Medicaid Drug Rebate process. This includes validating, verifying, disputing when necessary, and remitting payment for assigned state Medicaid agencies, SPAPs, and Supplemental Rebates.
The successful candidate will be accountable for submitting payments within deadlines and in compliance with CMS guidelines and Teva rebate contract terms.
Key Responsibilities- Work with assigned states to obtain Medicaid Summary invoices, summary data files, and Claim Level Invoices each quarter, and review to ensure completeness of information received.
- Upload data into Medicaid systems and authorize transactions, documenting errors and performing research.
- Conduct initial quality checks on summary data on all claim submissions to ensure rebate eligibility and data consistency.
- Perform Claim Level Detail validation, reviewing suspect claim records and determining if records 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.
- Provide backup for Medicaid team members in any necessary functions and work with the team to establish best practices within Teva's Medicaid work environment.
To be successful in this role, you will need:
- Bachelor's degree or equivalent combination of experience, training, and/or direct work-related experience.
- Prior Medicaid Claim processing experience with a Pharmaceutical and/or med Device company, state, and/or state agency, or as a Medicaid consultant or equivalent work experience.
- Minimum 2+ years of pharmaceutical/product-focused healthcare experience, Medicaid Claim processing function, manipulation of large datasets, negotiation/conflict resolution, system implementation, and report writing.
- Knowledge of the Model N or Revitas/Flex Medicaid and/or Flex Validata system (or other comparable system) and advanced Microsoft Excel skills.
- Familiarity 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.
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.
At Teva Pharmaceuticals, we are committed to equal opportunity in employment and strive to create a diverse and inclusive workplace for all.
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