Medicaid Claims Analyst

Teva Pharmaceuticals; Lake Hiawatha (NJ); On-site; USD 59,000 - 98,000; Full time

Job summary

An established industry player is seeking a Medicaid Claims Analyst to manage the Medicaid Drug Rebate process. This role involves validating and verifying claims, ensuring compliance with CMS guidelines, and resolving disputes. The ideal candidate will have experience in Medicaid claims processing and a strong analytical background. Join a forward-thinking company that values innovation and offers a competitive benefits package, including comprehensive health insurance and a 401(k) plan. Be part of a team that is committed to improving health and access to quality solutions for patients.

Benefits

Comprehensive Health Insurance

401(k) with Employer Match

Paid Time Off

Life and Disability Protection

Qualifications

• Experience in Medicaid claims processing and validation.
• Strong analytical skills with attention to detail.

Responsibilities

• Validate and verify Medicaid claims for compliance.
• Resolve disputes and document findings for state programs.

Skills

Medicaid Claims Processing

Data Analysis

Conflict Resolution

Attention to Detail

Education

High School Diploma

Bachelor's Degree

Tools

Model N

Microsoft Excel

Job description

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Join to apply for the Medicaid Claims Analyst role at Teva Pharmaceuticals

Teva is a global pharmaceutical leader and the world's largest generic medicines producer, committed to improving health and increasing access to quality health solutions worldwide. Our employees are at the core of our success, with colleagues in over 80 countries delivering the world's largest medicine cabinet to 200 million people every day. We offer a uniquely diverse portfolio of products and solutions for patients and we've built a promising pipeline centered around our core therapeutic areas. We are continually developing patient-centric solutions and significantly growing both our generic and specialty medicines business through investment in research and development, marketing, business development and innovation. This is how we improve health and enable people to live better, healthier lives. Join us on our journey of growth!

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.

• 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 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.

Company/Industry Related Knowledge:

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

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.

Already Working @TEVA?

If you are a current Teva employee, please apply using the internal career site available on "Employee Central". By doing so, your application will be treated with priority. You will also be able to see opportunities that are open exclusively to Teva employees. Use the following link to search and apply: Internal Career Site

The internal career site is available from your home network as well. If you have trouble accessing your EC account, please contact your local HR/IT partner.

Teva’s Equal Employment Opportunity Commitment

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. If you are contacted for a job opportunity, please advise us of any accommodations needed to support you throughout the recruitment and selection process. All accommodation information provided will be treated as confidential and used only for the purpose of providing an accessible candidate experience.

Important notice to Employment Agencies - Please Read Carefully

Teva Pharmaceuticals USA does not accept unsolicited assistance from agencies for employment opportunities. All CVs / resumes submitted by search firms to any employee at our company without a valid written search agreement in place for this position will be deemed the sole property of our company. No fee will be paid in the event a candidate is hired by our company as a result of an agency referral where no pre-existing agreement is in place. Where agency agreements are in place, introductions are position specific. Please, no phone calls or emails.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Analyst

• Industries

  Pharmaceutical Manufacturing

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