Medicaid Claims Analyst

Who we are

Together, we’re on a mission to make good health more affordable and accessible, to help millions around the world enjoy healthier lives. It’s a mission that bonds our people across nearly 60 countries and a rich, diverse variety of nationalities and backgrounds. Working here means working with the world’s leading manufacturer of generic medicines, and the proud producer of many of the products on the World Health Organization’s Essential Medicines List. Today, at least 200 million people around the world take one of our medicines every single day. An amazing number, but we’re always looking for new ways to continue making a difference, and new people to make a difference with.

The opportunity

Position Summary: 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.  

 

This role is a hybrid role and can report to either the Parsippany, NJ site or North Wales, PA site, whichever is closet to the person selected.

Essential Duties & 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 determines 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. Must have ability to work independently and make recommendation on state disputes, apply proper amounts to be paid & ensure CMS codes are applied correctly; notify states of results/findings. 
• 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. 
• 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 Model N / Medicaid systems and authorize transactions.  Document errors and perform research    5%
• 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 determines 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. Must have ability to work independently and make recommendation on state disputes, apply proper amounts to be paid & ensure CMS codes are applied correctly; notify states of results/findings.    5%
• Complete Medicaid analyzes and documentation on assigned states/programs.  Communicate to manager for key findings and changes to state programs.     

Your experience and qualifications

Education Required:    

• High School Diploma required. Bachelor’s degree preferred. Any equivalent combination of experience, training and/or direct work related experience will be considered.

    
Experience Required:    

• 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 

 

Experience Preferred:    

• 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.

 

Specialized or Technical Knowledge, License, Certifications needed:    

• Knowledge of the Model N or Revitas/Flex Medicaid and/or Flex Validata system (or other comparable system) and advance Microsoft Excel skills.  
• Familiar with CMS Medicaid rules and state specific issues.  Up to date knowledge