Medicaid Claims & Rebates Analyst

JOB SUMMARY The Medicaid Claims Analyst is responsible for Medicaid Drug Rebate processing, including validating, verifying, disputing when necessary, and remitting payments for assigned state Medicaid agencies, SPAPs, and Supplemental Rebates. This role ensures compliance with CMS guidelines and rebate contract terms while supporting dispute resolution, audits, system upgrades, and ad hoc analysis. Key Responsibilities • Review Medicaid Summary invoices, summary data files, and Claim Level Invoices each quarter to ensure completeness. • Upload data into Medicaid systems and authorize transactions. • Conduct quality checks on claim submissions to ensure rebate eligibility and data consistency. • Perform Claim Level Detail validation and dispute suspect claim records when necessary. • Resolve disputes and recommend payment amounts for historical outstanding utilization. • Complete Medicaid analyses and documentation for assigned states/programs, communicating key findings to management. • Provide backup support for Medicaid team members and contribute to establishing best practices. • Assist with weekly pay run activities, SOX audits, and system upgrades/implementations. Required Qualifications • Bachelor's degree, High School Diploma, or equivalent combination of experience and training. • Prior Medicaid claim processing experience within a pharmaceutical or medical device company, state agency, or as a Medicaid consultant. • Minimum 2+ years of pharmaceutical/product-focused healthcare experience. • Strong skills in data manipulation, negotiation, conflict resolution, and report writing. • Advanced Microsoft Excel skills. • Knowledge of CMS Medicaid rules and state-specific issues. Preferred Qualifications • Experience with system implementation and report writing. • Familiarity with 340B covered entities and Medicaid validation rules. Certifications • Knowledge of Model N, Revitas/Flex, or Flex Validate systems required. #J-18808-Ljbffr