Medicaid Rebate Analyst-Model N, Revitas/Flex, Flex Validata/ Medicaid rebate systems
Job Summary:
The company is seeking a detail-oriented Medicaid Claims Analyst to support Medicaid Drug Rebate processing activities within a pharmaceutical environment. This role is responsible for validating, analyzing, disputing, and processing Medicaid claims while ensuring compliance with CMS guidelines and rebate contract requirements. The ideal candidate will have strong experience with Medicaid rebate processing systems, large dataset analysis, and pharmaceutical industry regulations.
Key Responsibilities:
• Review Medicaid Summary Invoices, summary data files, and Claim Level Invoices for completeness and accuracy
• Upload and authorize transactions within Medicaid rebate processing systems
• Perform Claim Level Detail validation and identify claims requiring dispute resolution
• Investigate discrepancies, document findings, and conduct detailed data research
• Analyze rebate eligibility and validate claim data consistency across submissions
• Resolve disputes related to historical utilization and recommend appropriate payment amounts
• Ensure CMS codes are applied accurately and communicate findings to state agencies when required
• Support weekly payment activities, audit preparation, system upgrades, and ad hoc analysis requests
• Organize, manipulate, and validate large datasets across multiple formats with high accuracy
• Collaborate with internal teams to establish best practices and improve operational efficiency
• Communicate key findings, state program updates, and process improvements to management
• Provide cross-functional support and backup assistance to Medicaid team members as needed
Required Qualifications:
• Bachelor’s degree or equivalent combination of education and relevant work experience
• Minimum 2+ years of pharmaceutical or healthcare industry experience focused on Medicaid claim processing
• Hands-on experience with Medicaid rebate processing within a pharmaceutical environment
• Strong experience using Model N, Revitas/Flex, Flex Validata, or similar Medicaid rebate systems
• Advanced Microsoft Excel skills including large dataset manipulation and analysis
• Strong understanding of CMS Medicaid rules and state-specific Medicaid requirements
• Experience performing claim validation, dispute resolution, and payment reconciliation
• Excellent analytical, organizational, and problem-solving skills
• Strong attention to detail with consistent accuracy in data validation activities
• Ability to work independently while managing multiple priorities and deadlines effectively
Preferred Qualifications:
• Experience supporting SOX audits and system implementation activities
• Knowledge of Medicaid validation rules and 340B covered entity requirements
• Experience with reporting, process improvement, and automation initiatives
• Familiarity with government pricing and pharmaceutical rebate programs
• Strong negotiation and conflict resolution experience
Benefits:
The Company offers the following benefits for this position, subject to applicable eligibility requirements: medical insurance, dental insurance, vision insurance, 401(k) retirement plan, life insurance, long-term disability insurance, short-term disability insurance, paid parking/public transportation, paid time off, paid sick and safe time, hours of paid vacation time, weeks of paid parental leave, and paid holidays annually – as applicable.
Pay Range: $60/hr to $70/hr
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The company is seeking a detail-oriented Medicaid Claims Analyst to support Medicaid Drug Rebate processing activities within a pharmaceutical environment. This role is responsible for validating, analyzing, disputing, and processing Medicaid claims while ensuring compliance with CMS guidelines and rebate contract requirements. The ideal candidate will have strong experience with Medicaid rebate processing systems, large dataset analysis, and pharmaceutical industry regulations.
Key Responsibilities:
• Review Medicaid Summary Invoices, summary data files, and Claim Level Invoices for completeness and accuracy
• Upload and authorize transactions within Medicaid rebate processing systems
• Perform Claim Level Detail validation and identify claims requiring dispute resolution
• Investigate discrepancies, document findings, and conduct detailed data research
• Analyze rebate eligibility and validate claim data consistency across submissions
• Resolve disputes related to historical utilization and recommend appropriate payment amounts
• Ensure CMS codes are applied accurately and communicate findings to state agencies when required
• Support weekly payment activities, audit preparation, system upgrades, and ad hoc analysis requests
• Organize, manipulate, and validate large datasets across multiple formats with high accuracy
• Collaborate with internal teams to establish best practices and improve operational efficiency
• Communicate key findings, state program updates, and process improvements to management
• Provide cross-functional support and backup assistance to Medicaid team members as needed
Required Qualifications:
• Bachelor’s degree or equivalent combination of education and relevant work experience
• Minimum 2+ years of pharmaceutical or healthcare industry experience focused on Medicaid claim processing
• Hands-on experience with Medicaid rebate processing within a pharmaceutical environment
• Strong experience using Model N, Revitas/Flex, Flex Validata, or similar Medicaid rebate systems
• Advanced Microsoft Excel skills including large dataset manipulation and analysis
• Strong understanding of CMS Medicaid rules and state-specific Medicaid requirements
• Experience performing claim validation, dispute resolution, and payment reconciliation
• Excellent analytical, organizational, and problem-solving skills
• Strong attention to detail with consistent accuracy in data validation activities
• Ability to work independently while managing multiple priorities and deadlines effectively
Preferred Qualifications:
• Experience supporting SOX audits and system implementation activities
• Knowledge of Medicaid validation rules and 340B covered entity requirements
• Experience with reporting, process improvement, and automation initiatives
• Familiarity with government pricing and pharmaceutical rebate programs
• Strong negotiation and conflict resolution experience
Benefits:
The Company offers the following benefits for this position, subject to applicable eligibility requirements: medical insurance, dental insurance, vision insurance, 401(k) retirement plan, life insurance, long-term disability insurance, short-term disability insurance, paid parking/public transportation, paid time off, paid sick and safe time, hours of paid vacation time, weeks of paid parental leave, and paid holidays annually – as applicable.
Pay Range: $60/hr to $70/hr
Apply tot his job
Apply To this Job