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Managed Care Rebate Specialist
2 months ago
Hours Per Day: 8
Hours Per Week: 40
Position Overview:
Title: Managed Care Rebate Analyst/Consultant
Shift: Monday – Friday 8:00 am – 5:00 pm - Hybrid or remote - Hybrid Tuesday and Wednesday onsite and Monday, Thursday and Friday.
Temp to Perm: Contingent with the possibility to extend
Essential Qualifications:
• At least 2 years of experience in processing Managed Care Rebates for Pharmaceutical Manufacturers
• Comprehensive knowledge of Pharmacy Benefit Manager (PBM) networks and drug formularies
• Familiarity with various Managed Care rebate and fee structures, including Base Rebates, Administrative Fees, and Price Inflation Rebates
• Minimum 2 years of experience with Model N/Flex, Legacy Model N, or Revitas systems
• Proficient in Excel (including pivot tables and vlookups)
• Strong analytical capabilities
Job Responsibilities:
The Managed Care Rebate Analyst/Consultant plays a crucial role in managing the processing of Managed Care Commercial, Medicare Part D, Managed Medicaid, and Medical Agreement rebate claims. This role ensures compliance with rebate contract terms and internal processing protocols. Key responsibilities include:
• Analyzing utilization data to determine claim eligibility and applying appropriate rebate percentages
• Interpreting contract specifications and maintaining accurate plans, products, and reimbursement thresholds within the Model N/Flex System
• Validating the completeness and accuracy of utilization data
• Excluding ineligible claims based on established criteria (duplicates, ineligible pharmacies, etc.)
• Processing rebates through Model N/Flex Revenue Manager Submissions, Adjudications, and Settlement Modules, addressing errors as necessary
• Ensuring that calculated reimbursements receive the necessary approvals and are prepared for payment
• Monitoring invoice and calculation discrepancies, providing analysis for significant variances
• Assisting with system testing as required
• Communicating payment calculation details and rejected claim explanations to management and/or clients.
Experience and Skills Required:
• Extensive experience with Model N/Flex – Validata and Revenue Manager modules; validating utilization data from PBMs, managing contracts, and processing rebates
• Intermediate Excel proficiency – strong experience with pivot tables and vlookups
• Exceptional analytical skills
• Strong communication abilities
Note: Candidates must be eligible to work on a W2 basis without any visa sponsorship. Relocation assistance is not available for non-local candidates.
