Medical Claims Analyst (Rebate Process)- Remote

Industry: Pharmaceutical 

Job Title:  Medical Claims Analyst (Rebate Process)- 100% Remote

Duration: 03+ Months Contract (+Potential for extension)

Pay Range: $30-$50/hr

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  The Medicaid Claims Analyst is responsible for managing the Medicaid Drug Rebate process. This includes validating, verifying, disputing when necessary, and remitting payments for assigned state Medicaid agencies, SPAPs, and Supplemental Rebates. The Analyst ensures that payments are submitted within deadlines and in compliance with CMS guidelines and rebate contract terms.

  
  


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  Additionally, the role involves resolving disputes, participating in weekly pay run activities, assisting with SOX audits, system upgrades/implementations, and conducting ad hoc analysis.

  
  

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  Collaborate with assigned states to obtain Medicaid Summary invoices, summary data files, and Claim Level Invoices each quarter. Review for completeness and upload data into Medicaid systems, authorizing transactions and documenting errors.
  


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  Conduct initial quality checks on summary data for all claim submissions to ensure rebate eligibility and data consistency.
  


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  Perform Claim Level Detail validation, reviewing suspect claim records to determine if they should be disputed for payment.
  


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  Resolve disputes and propose recommended payment amounts for historical outstanding utilization submitted with Medicaid claims. Work independently to make recommendations on state disputes, apply proper payment amounts, and ensure CMS codes are correctly applied.
  


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  Complete Medicaid analyses and documentation for assigned states/programs, communicating key findings and changes to state programs to management.
  


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  Provide backup support for Medicaid team members and collaborate with the team to establish best practices within the Medicaid work environment.
  

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  Minimum of 2+ years of pharmaceutical/product-focused healthcare experience, particularly in Medicaid Claim processing.
  


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  Experience in Medicaid rebate processing within a pharmaceutical environment.
  


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  Prior experience with Medicaid Claim processing in a Pharmaceutical and/or Medical Device company, state agency, or as a Medicaid consultant.
  


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  Proficiency in Revitas/Flex Medicaid and advanced Excel skills.
  


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  Strong organizational skills with the ability to manipulate large volumes of data in various formats.
  


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  Attention to detail and a high degree of accuracy in data processing and reviews.
  


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  Experience in system implementation and report writing.
  


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  Skills in negotiation and conflict resolution.