Medicaid Reconciliation Analyst

About the role

We are seeking an experienced Medicaid Analyst responsible for the Medicaid Drug Rebate process, including validating, verifying, disputing when necessary, and remitting payment for assigned state Medicaid agencies, SPAPs, and Supplemental Rebates. This role ensures payments are submitted within deadlines and in compliance with CMS guidelines and rebate contract terms. Additional responsibilities include resolving dispute resolution, supporting weekly pay run activities, SOX audits, system upgrades/implementations, and ad hoc analysis.

Work Location: 2 to 3 days onsite in the North/Central, New Jersey area
Duration: 6 months

Responsibilities

• Work with assigned states to obtain Medicaid Summary invoice, summary data file, and Claim Level Invoice each quarter; review for completeness.
• Upload data into Medicaid systems (e.g., Model N) and authorize transactions.
• Document errors and perform research; conduct initial quality checks on summary data for rebate eligibility and consistency.
• Perform Claim Level Detail validation; review suspect claim records and determine if disputes are necessary.
• Resolve disputes and propose recommended payment amounts for historical outstanding utilization submitted with Medicaid claims.
• Work independently to make recommendations on state disputes, apply proper payment amounts, and ensure correct CMS codes are used; notify states of results/findings.
• Complete Medicaid analyses and documentation for assigned states/programs; communicate key findings and changes to management.
• Provide backup support for Medicaid team members and collaborate to establish best practices.
• Assist with system implementation, report writing, and SOX audit activities.

Requirements

• High School Diploma required; Bachelor’s degree preferred. Equivalent combination of experience, training, or direct work experience will be considered.
• Minimum of 2+ years of pharmaceutical/product-focused healthcare experience, specifically in Medicaid Claim processing.
• Prior experience with a Pharmaceutical and/or Medical Device company, state agency, or as a Medicaid consultant.
• Experience with manipulation of large datasets, negotiation, and conflict resolution.
• Knowledge of Model N, Revitas/Flex Medicaid, or Flex Validata systems (or comparable systems).
• Advanced Microsoft Excel skills.
• Familiarity with CMS Medicaid rules, state-specific issues, and Medicaid Validation rules (including 340B covered entities).
• Strong ability to organize and manipulate large volumes of data in various formats.
• High attention to detail and accuracy in data processing and reviews.

Pay

Pay Rate Range: $55/hr–$70/hr

Benefits

• Medical, Dental, and Vision Insurance
• Life Insurance and Disability Insurance
• 401(k) Savings Plan
• Employee Stock Purchase Plan
• Professional Development Program
• Paid Time Off and Paid Sick Time (where legally required)