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Senior Medicaid Analyst

Date: Jan 17, 2019

Location: Parsippany, New Jersey, US, 07054

Company: Teva Pharmaceuticals

Company Info

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!

Job Description

Position Summary:  

  • Administers the receipt, validation, dispute and payment of the rebate claims for both brand and generic NDCS from States.
  • Processes each claim in accordance with CMS guidelines and Teva contract terms and conditions with the state. Research and resolve dispute resolution timely.
  • Performs special analyses on claim data as requested.

The Medicaid Analyst reports to the Senior Manager of Medicaid. This position is a Shared Service position and provides support for all Teva products.

Essential Duties & Responsibilities 

  1. Download and organize Medicaid Summary invoice, summary data file and Claim Level Invoice using RPA tool.   Upload data into Model N systems (Flex and Validata).
  2. Conduct initial quality check on summary data on all claim submissions to ensure rebate eligibility and data consistency.
  1. Perform Claim Level Detail validation. Review suspect claim records and determines if record should be disputed for payment. 
  1. 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.
  1. Reconcile open balance show on Teva’s book verses Outstanding principal on Medicaid invoice.
  1. Complete Medicaid analyzes and documentation on assigned state/programs.  Communicate to managers for key findings.
  1. Provide backup for Medicaid team members in any necessary functions and work with team to establish best practices within Teva Medicaid work environment.
  1. Work with Sr. Manager & GP team to resolve RPUs & update QTR Package Price(s) in Revitas/Flex.
  2. Provide support on ad hoc analytics and process improvement projects. 

 

Qualifications

 

Position Requirements:

Education Required:

 

 

Bachelor’s Degree Required

 

Education Preferred

MBA preferred

Experience Required:

Minimum of 3-5 years of hands on Medicaid Claim processing experience with Pharmaceutical company , state and/or state agency, pharmaceutical consulting company

 

Experience Preferred:

Pharmaceutical Industry experience ; Medicaid Claim processing function; manipulation of large datasets, negotiation/conflict resolution

 

Specialized or Technical Knowledge, License, Certifications needed:

Must have Intermediate to advanced knowledge of the Model N or Revitas/Flex Medicaid and/or Flex Validata system (or other comparable system) and advance Microsoft Excel skills. 

Validata, Oracle, SAP, Business Intelligence, Oracle Discoverer, Tableau preferred

 

 

Company/Industry Related Knowledge:

Medicaid, Government Pricing, 340B and Rebate;  pharmaceutical industry experience/knowledge preferred.

 

Job Competencies :

 

Excellence in Execution:

Demonstrates initiative and creates an appropriate level of urgency to meet department objectives and quarterly deadlines. Strong ability to organize and manipulate large volume of data in various formats.

 

Function

Marketing

Sub Function

Market Access

Reports To

Director, Analytics & Rebate Forecasting, Acct Mgmt Mtgs (NA CNS) (US Market Access Pricing & Contracting)

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, national or ethnic origin or any other legally recognized status entitled to protection under applicable laws.


Nearest Major Market: New York City
Nearest Secondary Market: Newark