Job Description: The Analyst, Government Contract Operations position is responsible for the review, validation, processing and preparation for timely payments of current quarter as well as all prior quarter adjustments of Medicaid, MCO, Supplemental, ADAP, SPAP and J-Code Claims. Additionally, this position will be the lead liaison between s-a and State Medicaid Representatives regarding invoice processing/reconciliation and all aspects of the Dispute Resolution Process.
JOB DUTIES AND RESPONSIBILITIES:
Requirements: • Bachelor’s Degree or equivalent 1-2 years pharmaceutical/Medicaid work-related experience
- Review quarterly invoices for completeness to Process Medicaid rebate payments by the required due date.
- Audit/validate Medicaid rebate claims utilizing DNA data and claim level detail from State Program to ensure accurate units/unit of measure submitted by the State.
- For Supplementals, confirm PDL status and review all current contracts/agreements to determine proper treatment of rebates. Maintain formula in HCRS for Supplemental contracts.
- Complete all aspects of the claim invoice processing, ensure that payment is accurate and prepare payment vouchers for claims submission to accounts payable in a timely manner and as defined in the SOP.
- Develop and maintain all control documentation to support SOX compliance.
- Analyze and prepare proposals/settlements for all Medicaid, MCO, Supplemental, ADAP, SPAP and J-Code disputes. Work in collaboration with State to resolve disputes in a timely manner.
- Provide continual updates and maintenance of the Government Contracts User Guides (Medicaid, IFF Payment User Guide, PHS User Guide, CoC User Guide, etc.).
- Assist with audits, legal requests, ad-hoc reporting and special data requests.
- Provide operational support, (membership/product/pricing) updates to the Federal Contracts (FSS, BPA's and PHS).
- Assist with User Testing for all Systems (HCRS, ECP and CARS).
- Provide continual monitoring of all current Tracking Account Customers as well as renegotiation of new customers as required.
- Provide operational support (rebate processing) for TRICARE Rebates.
- Prepare Modification Forms for product adds, product deletes, price decreases and CoC changes in a timely manner. On a weekly basis, monitor all current Tracking Account Customers.
- I-MANY CARS Experience a plus.
- Demonstrated ability to handle multiple simultaneous tasks.
- Excellent communication skills oral and written.
- Excellent PC skills including Excel, Word, PowerPoint, Powerplay, Impromptu
- Detail oriented with strong interpersonal, organizational and presentation skills
- Knowledge of OBRA 90’ and 93” a plus
- Fundamental level of knowledge/analytical skills to enable accurate and timely reimbursement of State claims
Genzyme - 15 months ago