Medicaid Rebate & Claims Specialist

SGS Consulting; New York (NY); On-site; USD 70,000 - 110,000; Full time

Job summary

SGS Consulting seeks a Medicaid data specialist to process quarterly invoices, validate claim-level data, and upload to Model N/Medicaid systems. You will resolve discrepancies and document errors while ensuring rebate eligibility and data integrity.

The role requires independent analysis, attention to detail, and strong Excel and data manipulation skills, with experience in Medicaid processing within the pharmaceutical sector.

Qualifications

• Experience with Medicaid invoicing and rebate processing in a pharma/healthcare setting.
• Experience handling large data sets and writing/maintaining audit trails.
• Knowledge of CMS Medicaid rules and state-specific issues is a plus.

Responsibilities

• Work with assigned states to obtain Medicaid Summary invoice and related data quarterly; upload into Medicaid systems and authorize transactions.
• Perform initial quality checks on summary data to ensure rebate eligibility and data consistency.
• Conduct Claim Level Detail validation and resolve disputes for historical utilization submissions.
• Notify states of results/findings and document errors for research and process improvements.
• Provide backup support to Medicaid team and help establish best practices within the work environment.

Skills

Pharmaceutical experience

Medicaid rebate experience

Medicaid claim processing

Excel skills

Data manipulation

Attention to detail

Education

Bachelor's degree

High school diploma

Tools

Model N

Revitas/Flex

Flex Validata

Job description

SGS Consulting seeks a Medicaid data specialist to process quarterly invoices, validate claim-level data, and upload to Model N/Medicaid systems. You will resolve discrepancies and document errors while ensuring rebate eligibility and data integrity.

The role requires independent analysis, attention to detail, and strong Excel and data manipulation skills, with experience in Medicaid processing within the pharmaceutical sector.