Medicaid Senior Analyst

Medicaid Senior Analyst

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). The ideal candidate brings strong operational discipline, knowledge of MDRP and 340B interfaces, and business acumen to improve accuracy, cycle time, and compliance.

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).

Qualifications - Skills & Requirements

Required

• Bachelor's degree in Accounting, Finance, Business, Supply Chain, Data/Analytics, or related field.
• 36 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) and ERP (e.g Oracle, NetSuite).
• 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)

Education & Experience

• BS/BA preferred.
• Minimum 3 years of experience.
• Generic Pharmaceutical experience highly preferred (generic or brand).

• Medical and Rx Benefits choice of four medical plans through Horizon. Rx automatically provided with medical benefits
• Dental Benefits with three dental plan options through CIGNA
• Vision Plan with two plan options through VSP
• Life Insurance, Basic Life and AD&D and Supplemental Life Insurance
• Disability Insurance, Voluntary Short-Term Disability and State Disability
• Long-Term Disability (LTD), State (short term) disability where applicable
• FSA (Flexible Spending Accounts) Both Health Care & Dependent Care Available
• HSA (Health Savings Account)
• 401(k) Plan - Through Fidelity / Employer Match / fully vested after 3 years
• Employee Assistance Program (EAP) - 100% Confidential and 100% company paid
• Critical Illness and Accidental Insurance
• Legal and Identity Theft Insurance
• Paid Time Off - Paid vacation, PTO, Holiday

Notice to Recruitment Agencies: Please note that we are not accepting unsolicited resumes or proposals from recruitment firms or agencies for this position. Thank you for your understanding.

Compensation Min USD $75,000.00/Yr. Max USD $90,000.00/Yr. Physical Requirements OFFICE POSITION - While performing the duties of this job the employee is required to: Stand, sit; talk, hear, and use hands and fingers to operate a computer and telephone keyboard reach, stoop kneel to install computer equipment Specific vision abilities required by this job include close vision requirements due to computer work Light to moderate lifting is required Moderate noise (i.e. business office with computers, phone, and printers, light traffic). Ability to sit at a computer terminal for an extended period of time Sedentary work Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Additional Physical Requirements Blood/Fluid Exposure Risk Category III: Tasks involve no exposure to blood, body fluids or tissues. Category I tasks are not a condition of employment.