Medicaid Senior Analyst

Medicaid Rebate Operations

• Manage the full invoice lifecycle for all 50 states and territories: receipt, validation, eligibility checks, unit/URA alignment, and timely payments in line with policy..
• Investigate and resolve invoice discrepancies (e.g., NDC/labeler mismatches, utilization anomalies, packaging conversions, dual‑eligible rejections, duplicate claims).
• Maintain accurate Unit Rebate Amount (URA) usage and coordination with Government Pricing for restatements/retroactive adjustments.
• Track and report weekly/Monthly status: open disputes, credits taken, average days to resolve, and aging.

Dispute Management & Analytics

• Analyze state utilization trends and outliers (e.g., spikes by NDC/state, abrupt mix changes).
• Lead structured dispute packages (data, rationale, precedent, correspondence) to states; monitor outcomes and escalate when needed.
• Build dashboards/KPIs for leadership (claims volume, acceptance rate, dispute success rate, recovery dollars, cycle time, resolution aging).

Supplemental Rebates & Contracts

• Administer state supplemental rebate programs: maintain contract repository, pricing terms/effective dates, product addenda, and termination/renewal calendars.
• Validate invoice adherence to supplemental rebate terms and coordinate accrual/true‑up with Finance.

Government Pricing & Policy Interface

• Collaborate with GP team on pricing changes impacting URA , NDC changes, product launches, and restatements.
• Support GP with data validation needed for CMS reporting and coordinate impacts to Medicaid rebates and GTN.
• Monitor 340B interactions and potential duplicate discount risk; ensure appropriate processes with covered entities/third‑party administrators.

Controls, Compliance & Documentation

• Maintain SOPs/work instructions for rebate processing, disputes, supplemental rebates, and evidence retention.
• Support internal/external audits (Medicaid, GP, 340B) with complete, accurate documentation and timely responses.

Systems, Data & Process Improvement

• Own day‑to‑day utilization of the Medicaid rebate system -iContracts and interfaces with ERP/BI tools.
• Drive automation and standardization to reduce manual touchpoints, error rates, and cycle times.
• Partner with IT/Data to improve data quality(inner NDCs, unit of measure, package size conversions) and enhance reporting.

Cross‑Functional Collaboration & GTN

• Work closely with Commercial Finance on accruals, true‑ups, cash forecasting, and gross‑to‑net analytics.
• Provide Medicaid insights for business cases (product launches, pricing actions, channel mix shifts).

Required

• Bachelor’s degree in Accounting, Finance, Business, Supply Chain, Data/Analytics, or related field.
• 3–6 years of relevant pharma experience, including Medicaid rebates 
• Hands‑on with a Medicaid rebate processing platform (e.g., iContract, Model N, Vistex/Revitas/Revenue Cloud, or similar) and ERP (e.gOracle, NetSuite).
• Strong Excel and data analysis skills; comfort with large datasets and reconciliations.
• Demonstrated understanding of MDRP fundamentals (AMP, Best Price, URA, invoicing cycles) and dispute methodologies.
• Proven ability to manage deadlines across multiple states while maintaining high accuracy and controls.

Preferred

• Experience with 340B, VA/FSS, TRICARE, and state supplemental rebate programs.
• Exposure to Government Pricing calculations (AMP, BP, NFAMP, PHS Ceiling Price).
• Knowledge of GTN accounting concepts (accruals, true‑ups, reserves)