Rebate Pharmacist / HCPCS–NDC Crosswalk Specialist (Remote)

S2Tech•Chesterfield, MO

9d•Remote

About The Position

We are seeking a highly specialized Rebate Pharmacist / HCPCS–NDC Crosswalk Specialist to support Medicaid pharmacy rebate and claims adjudication operations. This role is responsible for the development, maintenance, and governance of an HCPCS–NDC Crosswalk, a critical data asset used to determine rebate eligibility and payment outcomes for physician-administered drugs within a Medicaid environment. This is a niche role requiring prior hands-on experience managing HCPCS–NDC crosswalks for a state Medicaid program or Medicaid claims processor. The ideal candidate brings deep pharmacy domain expertise, strong analytical skills, and a clear understanding of how crosswalks impact CMS rebate invoicing and MMIS medical pharmacy claim decisions.

Requirements

Demonstrated, hands-on experience building, maintaining, or governing a HCPCS–NDC Crosswalk for a Medicaid program or Medicaid claims processor
Strong working knowledge of: Medicaid Drug Rebate Program (MDRP) Medical vs. pharmacy benefit drug processing Physician-administered drugs and HCPCS coding
Experience supporting MMIS or Medicaid claims adjudication workflows
Ability to interpret CMS guidance and state-specific rules and translate them into operational data logic

Nice To Haves

Pharmacy background (licensed or non-licensed)
Experience in rebate operations or rebate systems
Multi-state Medicaid experience

Responsibilities

Develop, maintain, and manage the HCPCS–NDC Crosswalk used for Medicaid medical pharmacy claims
Manually compile and validate crosswalk mappings using multiple data sources (e.g., CMS files, state guidance, manufacturer data, clinical references)
Ensure crosswalk accuracy for: Identifying claims eligible for CMS Medicaid Drug Rebate invoicing Supporting MMIS payment or denial decisions for physician-administered drugs
Analyze changes in HCPCS codes, NDCs, and drug coverage policies and assess downstream impacts
Collaborate with rebate operations, claims processing, and technical teams to resolve discrepancies and support production needs
Support audits, inquiries, and data validation efforts related to rebate submissions and medical pharmacy claims
Document crosswalk logic, assumptions, and state-specific rules, recognizing that implementations vary by Medicaid program