To Discuss more about this job opportunity, please reach out to Deepak Arya (LinkedIn URL www.linkedin.com/in/deepakarya8a79aa22a/), email your updated resume at Email deepak.arya@collabera.com. Thank you!

Pay Range: $50 to $60 per hour

Client Industry: Biopharmaceutical

Job Mode: Remote 

Duration: 06 Months Contract (Possibilities of Extension)

Job Summary:
We are seeking an experienced Medicaid Claims Analyst with strong pharmaceutical industry experience and expertise in Medicaid rebate processing. This role is responsible for validating, analyzing, disputing, and processing Medicaid rebate claims while ensuring compliance with CMS guidelines and rebate contract terms. The ideal candidate will have hands on experience with Model N and advanced Excel capabilities to manage large datasets and claim level detail reviews. The analyst will collaborate with state agencies and internal teams to resolve disputes, support audits, and improve rebate processing operations. This position requires excellent analytical skills, strong attention to detail, and the ability to work independently in a fast paced healthcare environment.

Key Responsibilities:

• Review Medicaid summary invoices, summary data files, and claim level invoices for completeness and accuracy.
• Upload and authorize transactions within Medicaid rebate systems while documenting errors and conducting research.
• Perform claim level detail validation and determine disputed records for payment review.
• Analyze suspect claims and ensure rebate eligibility and consistency of submitted data.
• Resolve disputes and recommend accurate payment amounts for outstanding utilization submissions.
• Apply CMS codes correctly and communicate findings and payment recommendations to state agencies.
• Support weekly pay run activities, audit requests, system upgrades, and implementation activities.
• Maintain accurate Medicaid analysis documentation and communicate key findings.
• Collaborate with team members to establish operational best practices and provide backup support when required.
• Organize and manipulate large datasets across multiple formats with a high degree of accuracy.

Required Qualifications:

• Minimum 2 years of pharmaceutical or healthcare industry experience focused on Medicaid claim processing.
• Hands on experience with Medicaid rebate processing within a pharmaceutical environment.
• Strong experience using Model N for Medicaid claims processing.
• Advanced Excel skills with the ability to organize and analyze large datasets.
• Strong understanding of CMS Medicaid rules and state specific rebate requirements.
• Experience handling claim level detail reviews and dispute resolution activities.
• Ability to work independently and manage multiple priorities.

Preferred Qualifications:

• Experience with Revitas Flex or Flex Validata systems.
• Knowledge of Medicaid validation rules and 340B covered entities.
• Experience supporting system implementation and report writing activities.
• Background supporting SOX audits and compliance related processes.
• Bachelor’s degree or equivalent work experience preferred.

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, longterm disability insurance, shortterm 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)