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Consulting
Hybrid up to 3 Days Onsite
Full time
North/Central New Jersey United States
Consulting
On Demand Talent
City
North/Central
Country
United States
State/Province
New Jersey
About This Role
We are seeking an experienced Medicaid Analyst responsible for Medicaid Drug Rebate process which includes validating, verifying, disputing when necessary, and remitting payment for assigned state Medicaid agencies, SPAPs and Supplemental Rebates.  Accountable for submitting payments within deadlines and in compliance with CMS guidelines and rebate contract terms. This position also provides assistance in resolving dispute resolution, weekly pay run activities, SOX audits, system upgrade/implementation and ad hoc analysis.

Work Location: 2 to 3 days onsite in the North/Central, New Jersey area

Duration: 6 months

Pay Rate Range: $55/hr-$70/hr

What You Will Work On
  • 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 organizations 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. 
  • 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.

What You Will Bring
  • High School Diploma required. Bachelor’s degree preferred. Any equivalent combination of experience, training and/or direct work related experience will be considered.
  • 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. REQUIRED
  • 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.
  • 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.

What You Can Expect
  • An inspirational place for you to do your best work, be engaged in meaningful ways, and continually develop the skills, competencies and qualities that set our team apart.
  • Compensation commensurate with your qualifications, experience, and other factors including geographic location, market and operational factors. 
  • Total Rewards include: Medical, Dental, Vision, Life Insurance, Disability Insurance, 401(k) Savings Plan, Employee Stock Purchase Plan, Professional Development Program, Paid Time Off and Paid Sick Time (in geographies where legally required).
What We Do
At RGP, we're creating a future where businesses produce their best work without constraints. We've built a global network of over 2,600 experts across four regions, providing a comprehensive suite of solutions across on-demand talent, next-generation consulting, and outsourced services to support organizations at every stage of their growth journey. Trusted by Fortune 100 companies and emerging disruptors alike, we challenge conventional ways of working, drive growth, and pave the way for long-term success through bold innovation and fearless collaboration.

Our values guide everything we do and strengthen our commitment to people. By combining smart processes, human-centered design, and advanced technology, we celebrate our team's excellence and ensure we grow together. We believe in the power of continuous learning and development to drive both individual and organizational success. It’s time to rethink how work gets done. Dare to Work Differently® with RGP.

RGP is proud to be an Equal Opportunity Employer and committed to creating an inclusive environment for all employees. We do not discriminate on the basis of race, color, religion, national origin, gender, pregnancy, sexual orientation, gender identity, age, physical or mental disability, genetic information, veteran status, or any other legally protected trait and encourage all applicants to apply. 
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