Teva Medicaid Claims Analyst 

United States, New Jersey 

391414299

Essential Duties & 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 Teva Medicaid work environment.
• 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 Model N / Medicaid systems and authorize transactions. Document errors and perform research 5%
• 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. 5%
• Complete Medicaid analyzes and documentation on assigned states/programs. Communicate to manager for key findings and changes to state programs.

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 med 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, License, Certifications needed:

• 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.
• 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.

Company/Industry Related Knowledge:

• Medicaid, Government Pricing and Rebate Pharmaceutical industry experience/knowledge prefer.

We offer a competitive benefits package, including:

• Comprehensive Health Insurance: Medical, Dental, Vision, and Prescription coverage starting on the first day of employment, providing 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.
• Additional benefits include, but are not limited to, Employee Assistance Program, Employee Stock Purchase Plan, Tuition Assistance, Flexible Spending Accounts, Health Savings Account, Life Style Spending Account, Volunteer Time Off, Paid Parental Leave, if eligible , Family Building Benefits, Virtual Physical Therapy, Accident, Critical Illness and Hospital Indemnity Insurances, Identity Theft Protection, Legal Plan, Voluntary Life Insurance and Long Term Disability and more.

The total compensation may also include restricted stock units and discretionary awards, depending on the position offered. Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

The internal career site is available from your home network as well. If you have trouble accessing your EC account, please contact your local HR/IT partner.