Medicaid Claims Analyst

Teva Pharmaceuticals • Parsippany-Troy Hills, NJ

277d

About The Position

The Medicaid Claims Analyst is responsible for Medicaid Drug Rebate process which includes validating, verifying, disputing when necessary, and remitting payment for assigned state Medicaid agencies, SPAPs and Supplemental Rebates. 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.

Requirements

• High School Diploma required. Bachelor's degree preferred.
• 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.
• 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 volume of data in various formats.
• Attention to detail and high degree of accuracy in data processing and reviews.

Nice To Haves

• Minimum of 2+ years pharmaceutical/product focused healthcare experience.
• Medicaid Claim processing function.
• Manipulation of large datasets, negotiation/conflict resolution.
• System Implementation and report writing.

Responsibilities

• 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.
• Complete Medicaid analyzes 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 team to establish best practices within Teva Medicaid work environment.

Benefits

• Comprehensive Health Insurance: Medical, Dental, Vision, and Prescription coverage starting on the first day of employment.
• Retirement Savings: 401(k) with employer match, up to 6% and an annual 3.75% Defined Contribution to the 401k plan.
• Paid Time Off including vacation, sick/safe time, caretaker time and holidays.
• Company paid Life and Disability insurance.
• Employee Assistance Program.
• Employee Stock Purchase Plan.
• Tuition Assistance.
• Flexible Spending Accounts.
• Health Savings Account.
• Life Style Spending Account.
• Volunteer Time Off.
• Paid Parental Leave, if eligible.
• Family Building Benefits.
• Virtual Physical Therapy.
• Accident, Critical Illness and Hospital Indemnity Insurances.
• Identity Theft Protection.
• Legal Plan.
• Voluntary Life Insurance and Long Term Disability.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Chemical Manufacturing
• Education Level: High school or GED