Medicaid Claims Analyst- Pharmaceutical

Industry: Pharmaceutical

Job Title: Medicaid Claims Analyst

Location: Remote

Duration: 90-Day Contract (Possible Extension)

Work Schedule: Monday-Friday, 8:00 AM - 5:00 PM ET

Pay : $60-65/ hr 

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)

• The Medicaid Claims Analyst is responsible for executing the Medicaid Drug Rebate process, including claim validation, dispute assessment, payment reconciliation, and compliance with CMS guidelines and internal contract requirements.


• The role requires hands-on Medicaid claim processing experience within a pharmaceutical setting and the ability to manage large datasets with high accuracy.


• The ideal candidate has strong analytical skills, advanced Excel proficiency, and experience with Medicaid rebate systems such as Model N, Revitas, or Flex Medicaid.

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  Manage the Medicaid Drug Rebate process for assigned states, including validation, verification, dispute assessment, and payment remittance.

  
  


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  Ensure rebate payments are submitted accurately and on time in alignment with CMS requirements and contract terms.

  
  


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  Obtain and review quarterly Medicaid summary invoices, data files, and claim-level detail for accuracy and completeness.

  
  


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  Conduct initial quality checks on claim submissions to confirm rebate eligibility and data consistency.

  
  


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  Perform claim-level detail validation and determine disputes when necessary.

  
  


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  Resolve disputes by analyzing claim records, applying appropriate CMS codes, and recommending payment adjustments.

  
  


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  Complete Medicaid analyses and necessary documentation for assigned programs.

  
  


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  Communicate findings and state program changes to management.

  
  


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  Support weekly pay run activities, audit requests, system upgrades, and ad hoc analyses.

  
  


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  Provide backup support for Medicaid team members and contribute to process improvements.

  
  

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

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  Prior Medicaid claim processing experience within a pharmaceutical or medical device company, state agency, or Medicaid consultancy.

  
  


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  Minimum 2 years of pharmaceutical or healthcare experience involving Medicaid claims, rebate processing, or government pricing.

  
  


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  Proven ability to analyze and manipulate large datasets, identify discrepancies, and manage dispute resolution.

  
  


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  Experience supporting system implementations, audits, or compliance-driven reporting.

  
  

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  Proficiency with Model N, Revitas/Flex Medicaid, or comparable rebate management systems.

  
  


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  Advanced MS Excel skills (pivot tables, lookups, conditional formulas, reconciliation).

  
  


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  Knowledge of CMS Medicaid rules, 340B entities, and validation procedures.

  
  


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  Strong attention to detail, accuracy, and data quality.

  
  


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  Exposure to SOX audits, data validation, or system upgrades.

  
  


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  Experience in Government Pricing or Rebate operations within the pharmaceutical industry.

  
  


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  Strong analytical and data interpretation capabilities.
  


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  Ability to identify process improvement opportunities through standardization and automation.

  
  


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  Continuously expands technical skills and business knowledge.

  
  


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  Supports team collaboration and best practice sharing.

  
  


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  Builds effective relationships with internal and external stakeholders.
  


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  Demonstrates integrity, credibility, and professionalism.

  
  


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  Meets deadlines, manages multiple priorities, and demonstrates urgency and accuracy.
  


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  Strong understanding of rebate systems, accounting accuracy, and internal controls.
  


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  Advanced Excel and data management skills.

  
  


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  Extensive pharmaceutical industry knowledge and Medicaid rebate expertise.

  
  


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  Ability to work independently in a fast-paced, data-driven environment.

  
  


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  High attention to compliance, accuracy, and documentation quality.

  
  


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  Effective communication skills with cross-functional partners.