Medicaid Claims Analyst

Medicaid Claims Analyst

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

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 closest to the person selected.

How You'll Spend Your Day

• 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.

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 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. Medicaid, Government Pricing and Rebate Pharmaceutical industry experience / knowledge prefer.

Compensation Data

The annual starting salary for this position is between $70,000 95,000 annually. Factors which may affect starting salary within this range and level of role may include geography / market, skills, education, experience and other qualifications of the successful candidate.

Enjoy a More Rewarding Choice

We offer a competitive benefits package, including : Comprehensive Health Insurance : Medical, Dental, Vision, and Prescription coverage starting on the first day of employment, providing the employee enrolls. Retirement Savings : 401(k) with employer match, up to 6% and an annual 3.75% Defined Contribution to the 401k plan. Time Off : Paid Time Off including vacation, sick / safe time, caretaker time and holidays. Life and Disability Protection : Company paid Life and Disability insurance. The total compensation package for this position may also include other elements, including a sign-on bonus, restricted stock units, and discretionary awards in addition to a full range of medical, financial, and / or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered. Details of participation in these benefit plans will be provided if an employee receives an offer of employment. If hired, employee will be in an "at-will position" and the company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, company or individual department / team performance, and market factors.

Teva Pharmaceuticals is committed to equal opportunity in employment. It is Teva's global policy that equal employment opportunity be provided without regard to age, race, creed, color, religion, sex, disability, pregnancy, medical condition, sexual orientation, gender identity or expression, ancestry, veteran status, national or ethnic origin or any other legally recognized status entitled to protection under applicable laws. We are committed to a diverse and inclusive workplace for all.