Managed Care Analyst II - Pioneer Data Systems
Parsippany, NJ 07054
About the Job
Position Details:
Our client, a world-leading Pharmaceutical Company in Parsippany, NJ is currently looking for a Rebate/Chargeback/Claims Analyst (Medicaid, Medicare, PBM) to join their expanding team.
Job Title: Rebate/Chargeback/Claims Analyst (Medicaid, Medicare, PBM)
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
Our client, a world-leading Pharmaceutical Company in Parsippany, NJ is currently looking for a Rebate/Chargeback/Claims Analyst (Medicaid, Medicare, PBM) to join their expanding team.
Job Title: Rebate/Chargeback/Claims Analyst (Medicaid, Medicare, PBM)
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
Source : Pioneer Data Systems
