Medicaid Senior Analyst
About the role
The Medicaid Senior Analyst supports end-to-end operations of the Medicaid Drug Rebate Program (MDRP) and related government programs. This role oversees state invoice processing, dispute management, data integrity, supplemental rebate contract administration, and coordination of cross-functional inputs impacting government price reporting and Gross-to-Net (GTN).
Responsibilities
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.
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).
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.
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.
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.
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.
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).
Requirements
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).
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).