Job Title: Medicaid Claims Analyst - Pharmaceuticals

Location: Remote Role

Duration: 3 Months Contract (Extension/Conversion will be based on the performance)

Work Schedule: Monday–Friday, 8:00 AM – 5:00 PM EST

Remote: Fully remote option available for non-local candidates.

Pay Range: ($60-$65) hourly basis.

Job Description:

• We are seeking a Medicaid Claims Analyst with strong pharmaceutical industry experience to support the full Medicaid Drug Rebate process.
• This role is responsible for claim validation, dispute resolution, payment reconciliation, and ensuring compliance with CMS requirements and internal policies.
• The ideal candidate brings hands-on experience working with Medicaid claims, advanced data analysis skills, and proficiency in Medicaid rebate management systems.

Key Responsibilities:

• Manage the end-to-end Medicaid Drug Rebate process for assigned states, including claim validation, dispute assessment, and payment submission.
• Ensure accurate and timely rebate payments in compliance with CMS guidelines and contractual terms.
• Review quarterly Medicaid invoices, data files, and claim-level details for completeness and accuracy.
• Conduct initial quality checks to confirm claim eligibility and maintain data consistency.
• Analyze claim-level records, determine disputes, apply CMS dispute codes, and recommend payment adjustments as needed.
• Prepare Medicaid-related analysis, documentation, and reporting for internal stakeholders.
• Communicate findings, state updates, and issue resolutions to leadership.
• Support weekly payment runs, audits, system enhancements, and ad hoc analytical requests.
• Provide backup coverage for team members and contribute to process improvement initiatives.

Education:

• Bachelor’s Degree, High School Diploma, or equivalent combination of training and experience.

Required Experience:

• Prior Medicaid claim processing experience within the pharmaceutical, medical device, state Medicaid, or consulting environment.
• Minimum 2+ years of experience related to Medicaid claims, rebate processing, or government pricing.
• Demonstrated ability to manage and analyze large datasets, identify discrepancies, and resolve disputes.
• Experience supporting system implementations, audits, or compliance-driven reporting.

Technical Skills & Key Attributes:

• Proficiency in Model N, Revitas/Flex Medicaid, or similar rebate management platforms.
• Advanced Excel skills (pivot tables, lookups, conditional formulas, financial reconciliation).
• Strong understanding of CMS Medicaid regulations, 340B entities, claim validation rules, and rebate eligibility.
• Familiarity with SOX controls, data validation processes, and system upgrades.
• Experience in Government Pricing or Rebate Operations within the pharmaceutical industry.
• Excellent analytical, problem-solving, and data interpretation abilities.
• Strong attention to detail with a commitment to accuracy and documentation quality.
• Ability to identify opportunities for process automation and standardization.
• Effective communicator with strong collaboration skills across cross-functional teams.
• Ability to work independently in a fast-paced, data-driven, and compliance-focused environment.
• High level of professionalism, integrity, and accountability.

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, paid sick and safe time, hours of paid vacation time, weeks of paid parental leave, paid holidays annually - AS Applicable).