Tevapharm
The opportunity
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. This role is a hybrid role and can report to either the Parsippany, NJ site or North Wales, PA site, whichever is closest to the person selected.
Your day-to-day responsibilities
Work with assigned states to obtain Medicaid Summary invoices, summary data files, and Claim Level Invoices each quarter; review for completeness and upload data into Medicaid systems, authorizing transactions and documenting errors.
Conduct initial quality checks on summary data for all claim submissions to ensure rebate eligibility and data consistency.
Perform Claim Level Detail validation; review suspect claim records and determine if a record should be disputed for payment.
Resolve disputes and propose recommended payment amounts for historical utilization routinely submitted with Medicaid claims; work independently, apply proper amounts, ensure CMS codes are applied correctly, and notify states of results/findings.
Complete Medicaid analyses and documentation on assigned states/programs; communicate key findings and changes to state programs to the manager.
Provide backup for Medicaid team members and collaborate to establish best practices within Teva Medicaid work environment.
Work with assigned states to obtain Medicaid data quarterly in Model N / Medicaid systems and perform data validation and research as needed.
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 medical 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, Licenses, Certifications needed:
Knowledge of the Model N or Revitas/Flex Medicaid and/or Flex Validata system (or other comparable system) and advanced 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 volumes of data with high attention to detail and accuracy.
Company/Industry Related Knowledge:
Medicaid, Government Pricing and Rebate Pharmaceutical industry experience/knowledge preferred.
The annual starting salary for this position is between $70,000 – 95,000 annually. Factors which may affect starting salary within this range may include geography/market, skills, education, experience and other qualifications of the successful candidate.
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, provided 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 may include other elements, such as a sign-on bonus, restricted stock units, and discretionary awards, in addition to a full range of medical and other benefits. Participation details will be provided if an offer is extended.
Make a difference with Teva Pharmaceuticals Already Working @TEVA? If you are a current Teva employee, please apply using the internal career site available on Employee Central. This will prioritize your application and allow you to view opportunities exclusive to Teva employees. Internal Career Site
The internal career site is accessible from your home network. 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.
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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. This role is a hybrid role and can report to either the Parsippany, NJ site or North Wales, PA site, whichever is closest to the person selected.
Your day-to-day responsibilities
Work with assigned states to obtain Medicaid Summary invoices, summary data files, and Claim Level Invoices each quarter; review for completeness and upload data into Medicaid systems, authorizing transactions and documenting errors.
Conduct initial quality checks on summary data for all claim submissions to ensure rebate eligibility and data consistency.
Perform Claim Level Detail validation; review suspect claim records and determine if a record should be disputed for payment.
Resolve disputes and propose recommended payment amounts for historical utilization routinely submitted with Medicaid claims; work independently, apply proper amounts, ensure CMS codes are applied correctly, and notify states of results/findings.
Complete Medicaid analyses and documentation on assigned states/programs; communicate key findings and changes to state programs to the manager.
Provide backup for Medicaid team members and collaborate to establish best practices within Teva Medicaid work environment.
Work with assigned states to obtain Medicaid data quarterly in Model N / Medicaid systems and perform data validation and research as needed.
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 medical 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, Licenses, Certifications needed:
Knowledge of the Model N or Revitas/Flex Medicaid and/or Flex Validata system (or other comparable system) and advanced 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 volumes of data with high attention to detail and accuracy.
Company/Industry Related Knowledge:
Medicaid, Government Pricing and Rebate Pharmaceutical industry experience/knowledge preferred.
The annual starting salary for this position is between $70,000 – 95,000 annually. Factors which may affect starting salary within this range may include geography/market, skills, education, experience and other qualifications of the successful candidate.
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, provided 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 may include other elements, such as a sign-on bonus, restricted stock units, and discretionary awards, in addition to a full range of medical and other benefits. Participation details will be provided if an offer is extended.
Make a difference with Teva Pharmaceuticals Already Working @TEVA? If you are a current Teva employee, please apply using the internal career site available on Employee Central. This will prioritize your application and allow you to view opportunities exclusive to Teva employees. Internal Career Site
The internal career site is accessible from your home network. 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.
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