Managed Care Analyst II

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Job description

Position Details:

Our client, a world-leading Pharmaceutical Company in Parsippany, NJ is currently looking for a Rebate Analyst II (Medicaid, Medicare) to join their expanding team.

Job Title: Rebate Analyst II (Medicaid, Medicare) / REMOTE WORK

Duration: 9 months contract, extendable up to 24 months

Location: Parsippany, NJ

Hybrid Tuesday and Wednesday onsite and Monday, Thursday and Friday.

Note:

The client has the right-to-hire you as a permanent employee at any time during or after the end of the contract.

You may participate in the company group medical insurance plan

Job Description:

Title: Managed Care Rebate Analyst/Consultant

Shift:

Monday Friday 8:00am 5:00pm - Hybrid or remote - Hybrid Tuesday and Wednesday onsite and Monday, Thursday and Friday.

Temp to Perm:

Contingent with the possibility to extend

Core Essential Skill sets:

Minimum 2 years experience with Pharmaceutical Manufacturer processing Managed Care Rebates

Thorough understanding of PBM networks and drug formularies

Experience with all Managed Care rebate and fee types, including Base Rebates, Administrative Fees, Price Inflation Rebates

Minimum 2 years experience with Model N/Flex, Legacy Model N, or Revitas

Intermediate Excel Skills (pivot tables, vlookups)

Strong Analytical Skills

Job Description

The Managed Care Rebate Analyst/Consultant is responsible for the processing of Managed Care Commercial, Medicare Part D, Managed Medicaid, and Medical Agreement rebate claims in accordance with the terms and conditions of the rebate contract and internal processing procedures.

This position is responsible for analyzing utilization data, applying rules to determine included and excluded claims, assigning appropriate rebate percentages to utilization claims, and initiating payment to customers within contractual guidelines.

Must have a thorough understanding of PBM networks, drug formularies, and all Managed Care rebate and fee types, including Base Rebates, Administrative Fees, Price Inflation Rebates

Interpret contract language; input/maintain plans, products, and reimbursement thresholds in the Model N/Flex System

Analyzes utilization data for completeness and accuracy

Applies appropriate validations to utilization data; exclude ineligible claims (duplicates, ineligible pharmacies, aberrant quantities)

Processes rebates through Model N/Flex Revenue Manager Submissions, Adjudications and Settlement Modules, resolving all errors and rejecting lines where appropriate

Ensures calculated reimbursements are approved at all levels and prepared for payment

Tracks invoice and calculation amounts; analyzes and explains large variances period over period and invoice vs. calculated amounts

Assists with system testing as needed

Maintains and communicates payment calculation details and rejected claim explanation to management and/or customer

Experience and qualifications

Must have extensive experience with Model N/Flex Validata and Revenue Manager modules; Validating utilization data from PBMs, Managed Care Contract maintenance, and Managed Care Rebate Processing

Intermediate Excel Level extensive experience with pivot tables, vlookups

Exemplary Analytical skills

Strong Communication skills

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