Medicaid Drug Rebate Program Senior Specialist

State-of-Missour; Jefferson City (MO); On-site; USD 44,000 - 53,000; Full time

Job summary

MO HealthNet Division in Cole County is seeking a Benefit Program Senior Specialist for the Medicaid Drug Rebate Unit. The role focuses on managing manufacturer accounts and ensuring data accuracy in drug rebate claims.

You will analyze claims, resolve disputes, prepare reports, and monitor compliance with the MDRP. A Bachelor's degree and 1–3 years' experience are preferred; opportunities to impact state budget are significant.

Qualifications

• Bachelor’s degree and 1-3 years of relevant experience. Substitutions may be allowed.
• Lack of post-secondary education will not be used as the sole basis denying consideration to any applicant.
• Prefers experience within a pharmaceutical setting and collections background.

Responsibilities

• Manage pharmaceutical manufacturer accounts as assigned.
• Resolve disputes submitted by pharmaceutical manufacturers in response to invoices generated from drug claims data.
• Prepare routine reports and documentation needed to reconcile pharmaceutical manufacturer outstanding balances.
• Analyze and evaluate claims to identify patterns of utilization to recognize possible abuse or errors in claim filing.
• Review and evaluate detailed payment data from reports in order to identify and initiate recoupment and/or adjustment of claims.
• Monitor unit and program operations, regulations, procedures and audit recommendations to ensure compliance with CMS for the MDRP.
• Answer program inquiries from providers and pharmaceutical manufacturers.
• Locate, organize, and perform routine analysis on information from various sources pertaining to all aspects of the MDRP.
• Communicate effectively with manufacturers, providers and co-workers regarding program requirements related to the MDRP.
• Participate with other staff members in meetings to identify problem areas and develop solutions.

Skills

Written and verbal communication

Planning & prioritization

Pharmaceutical experience

Education

Bachelor’s degree

Job description

MO HealthNet Division in Cole County is seeking a Benefit Program Senior Specialist for the Medicaid Drug Rebate Unit. The role focuses on managing manufacturer accounts and ensuring data accuracy in drug rebate claims.

You will analyze claims, resolve disputes, prepare reports, and monitor compliance with the MDRP. A Bachelor's degree and 1–3 years' experience are preferred; opportunities to impact state budget are significant.