Aequor · 2 months ago
Drug Rebate Analyst
United States
Full-time
Remote
Entry, Mid Level
$50.56/hr - $70.78/hr
2+ years expAequor Technologies is seeking a Drug Rebate Analyst responsible for the Medicaid Drug Rebate process. The role involves validating, verifying, disputing, and remitting payments for assigned state Medicaid agencies, ensuring compliance with CMS guidelines.
ConsultingIT ManagementRecruiting
Responsibilities
Work with assigned states to get Medicaid Summary invoice, summary data file and Claim Level Invoice each quarter and review to ensure completeness of information received. Upload data into Medicaid systems and authorize transactions. Document errors and perform research
Conduct initial quality check on summary data on all claim submissions to ensure rebate eligibility and data consistency
Perform Claim Level Detail validation. Review suspect claim records and determines if record should be disputed for payment
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
Complete Medicaid analyzes and documentation on assigned states/programs. Communicate to manager for key findings and changes to state programs
Provide backup for Medicaid team members in any necessary functions and work with team to establish best practices within Medicaid work environment
Qualification
Required
Medicaid rebate experience in pharm environment
Prior Medicaid Claim processing experience with a Pharmaceutical and/or med Device company, state and/or state agency or as Medicaid consultant or equivalent work experience
Minimum 2+ years pharmaceutical/product focused healthcare experience
Medicaid Claim processing function; manipulation of large datasets, negotiation/conflict resolution. System Implementation and report writing
Revitas/Flex Medicaid and advance Microsoft Excel skills
Strong ability to organize and manipulate large volume of data in various formats
Attention to detail and high degree of accuracy in data processing and reviews
Bachelor's degree or equivalent combination of experience, training and/or direct work related experience
Knowledge of the Model N or Revitas/Flex Medicaid and/or Flex Validata system (or other comparable system) and advance 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
Company/Industry Related Knowledge: Medicaid, Government Pricing and Rebate Pharmaceutical industry experience/knowledge prefer
Company
Aequor
Since 1998, Aequor has provided exceptional workforce staffing services in multiple industries.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Kamalpreet S. Virdi
CEO & Chairman
Recent News
Staffing Industry Analysts
2023-12-24
2023-07-11
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