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Medicaid Claims Specialist
2 months ago
We are seeking a highly skilled Medicaid Claims Analyst to join our team at Teva Pharmaceuticals. As a Medicaid Claims Analyst, you will be responsible for ensuring the accuracy and efficiency of our Medicaid rebate process.
Key Responsibilities- Validate and verify Medicaid claims to ensure compliance with CMS guidelines and Teva rebate contract terms.
- Process and remit payments to assigned state Medicaid agencies, SPAPs, and Supplemental Rebates.
- Provide assistance in resolving dispute resolution, weekly pay run activities, SOX audits, system upgrade/implementation, and ad hoc analysis.
- Work with assigned states to obtain Medicaid Summary invoices, summary data files, and Claim Level Invoices, and review for completeness.
- Upload data into Medicaid systems and authorize transactions, documenting errors and performing research.
- Conduct initial quality checks on summary data 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.
- Communicate with managers and team members to ensure key findings and changes to state programs are addressed.
- 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 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, 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.
Teva Pharmaceuticals is a global pharmaceutical leader and the world's largest generic medicines producer. We are committed to improving health and increasing access to quality health solutions worldwide.
We offer a competitive benefits package, including Medical, Dental, Vision, and Prescription coverage, Disability and Life Insurance, Paid Time Off, 13 paid Holidays, 6% match on the 401(k), Employee Stock Purchase Plan, and Tuition Assistance.
