7 days old

Associate Director Medicaid

Parsippany, NJ 07054
Company Info

Teva is a global pharmaceutical leader and the world's largest generic medicines producer, committed to improving health and increasing access to quality health solutions worldwide. Our employees are at the core of our success, with colleagues in over 80 countries delivering the world's largest medicine cabinet to 200 million people every day. We offer a uniquely diverse portfolio of products and solutions for patients and we've built a promising pipeline centered around our core therapeutic areas.  We are continually developing patient-centric solutions and significantly growing both our generic and specialty medicines business through investment in research and development, marketing, business development and innovation. This is how we improve health and enable people to live better, healthier lives. Join us on our journey of growth!

Job Description

The Associate Director of Medicaid is responsible for ensuring that each assigned States rebate program adheres to all CMS and other applicable requirements. This position ensures that State federal and supplemental rebate programs are actively monitored, that appropriate staffing levels are maintained, training programs for both State and internal Medicaid analysts are accomplished, and the accurate publishing/documenting of communications addressing any changes in guidance for government programs and the Medicaid program that will impact other internal operations. This position drives continuous improvement initiatives and is accountable for all Medicaid rebate budget and financial forecasting.  The incumbent will be using Model Ns Flex program for Medicaid adjudications.  This position reports to the Senior Director, Business Finance.

  • Work with assigned states to get Medicaid Summary invoice, summary data file and Claim Level Invoice each quarter and review to ensure completeness of information received.   Upload data into Model N / Medicaid systems and authorize transactions.  Document errors and perform research
  • Conduct initial quality check on summary data on all claim submissions to ensure rebate eligibility and data consistency
  • Perform Claim Level Detail validation. Review suspect claim records and determines if record should be disputed for payment.
  • Resolve disputes and propose recommended amounts to be paid for historical outstanding utilization that is routinely submitted with Medicaid claims. Must have ability to work independently and make recommendation on state disputes, apply proper amounts to be paid & ensure CMS codes are applied correctly; notify states of results/findings.
  • Complete Medicaid analyzes and documentation on assigned states/programs.  Communicate to manager for key findings and changes to state programs.
  • Oversees and works in collaboration with the internal rebate managers, and supports the activities and requirements of each specific State Program Director and Account Rebate Manager, appropriate State agency rebate staff, and internal departments supporting the Medicaid FFS rebate team; oversees the States drug rebate program.
Qualifications
  • Bachelors degree with emphasis in Business, Finance, Accounting or related fields or equivalent combination of education, training and/or direct work related experience.
  • 3 + years experience Medicaid Claim processing experience with Pharmaceutical Company, state and/or state agency or as Medicaid consultant
  • Must have Intermediate to advanced knowledge of the Model N or Revitas/Flex Medicaid and/or Flex Validata system (or other comparable system) and advance Microsoft Excel skills. 

Preferred:

  • Masters degree
  • Pharmaceutical Industry experience; Medicaid Claim processing function; manipulation of large datasets, negotiation/conflict resolution.  System Implementation and report writing.
  • Familiar with CMS Medicaid rules and state specific issues.  Up to date knowledge on Medicaid Validation rules and issues with 340B covered entities.
  • Strong ability to organize and manipulate large volume of data in various formats.  Attention to detail and high degree of accuracy in data processing and reviews.
  • Medicaid, Government Pricing and Rebate Pharmaceutical industry experience
Function
Marketing
Sub Function
Managed Care Administration
Reports To

Senior Director, Business Finance      

Tevas Equal Employment Opportunity Commitment

Teva Pharmaceuticals is committed to equal opportunity in employment. It is Teva's global policy that equal employment opportunity be provided without regard to age, race, creed, color, religion, sex, disability, pregnancy, medical condition, sexual orientation, gender identity or expression, ancestry, veteran status, national or ethnic origin or any other legally recognized status entitled to protection under applicable laws.

Categories

Posted: 2019-11-05 Expires: 2019-12-05

Join us at the forefront of pharmaceutical research and production. With state-of-the-art facilities, highly skilled colleagues, and a high-powered organizational culture, Teva offers you countless possibilities to make a real difference in people's lives and add value to your career.

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Associate Director Medicaid

Teva Pharmaceuticals
Parsippany, NJ 07054

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