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Medicaid Specialist / Sr. Medicaid Specialist

Location: 

NC-RTP, US

Contract Type:  Regular Full-Time
Area:  Sales/Sales Operations
Req Id:  169829

Do you want to join an international team working to improve the future of healthcare? Do you want to improve the lives of millions of people? Grifols is a global healthcare company which, since its foundation in Barcelona in 1909, has been working to improve the health and well-being of people all over the world. Our four divisions - Bioscience, Diagnostic, Hospital and Bio Supplies - develop, produce and market innovative medicines, solutions and services in more than 100 countries and regions.

The Medicaid Specialist is responsible for the end-to-end Medicaid Drug Rebate process which includes validating, verifying, disputing when necessary, and remitting payment for state, SPAP, and Supplemental programs. This role will validate and analyze utilization trends against prescribed methods. The Medicaid Specialist ensures payments are submitted within aggressive deadlines.

 

Primary responsibilities:

  • Responsible for the accurate and timely process of the Medicaid rebate invoices as well as the tracking of these payments with internal stakeholders and various state agencies while following corporate controls/approved guidelines and SOX regulations
  • Demonstrate knowledge and understanding of the laws, regulations, and policies that pertain to the organizational business unit and conforms with these laws, regulations, and policies in carrying out the accountability of the job
  • Responsible for ensuring compliance with all state and federal mandated due dates and avoiding interest penalties
  • Ability to work with large amounts of data is required; evaluate claims level detail to ensure product dispensing is aligned with Grifols set guidelines and dispute accordingly
  • Responsible for negotiating dispute resolutions with state personnel while ensuring accurate and efficient documentation of payments
  • Knowledge of working under SOPs and work instruction process is required
  • Develop and maintain strong working relationships to facilitate the exchange of key information, understand and address needs, and clarify contract requirements with internal and external customers
  • Responsible for updating the Government Pricing Director with changes to state programs and drug placements
  • Assist other team members with projects and/or reports, as needed to ensure the department achieves its goals
  • Ability to handle multiple priorities simultaneously, with strong attention to detail, while meeting strict deadlines
  • Scan historical Medicaid rebate invoices and prepare paper files to be sent to an off-site storage facility
  • Additional responsibilities/duties may be assigned to meet departmental goals
     
    Knowledge, skills & abilities:
  • Advanced knowledge in the Microsoft Office suite is required
  • Knowledge of Medicaid processing through Model N (f.k.a. Revitas) Flex MRB is preferred but not required
  • Knowledge of state and federal rules and regulations that govern the Government Contracting area (Medicaid, Medicare, TRICARE, etc.) is desired
  • Strong interpersonal and oral/written communication skills are required
  • Knowledge of Medicaid processing is highly preferred
  • Ability to handle multiple priorities simultaneously, with strong attention to detail, while meeting strict deadlines
  • Excellent planning and time management skills
  • Solid concept of algebraic and financial formulas
  • Ability to multi-task in a fast-paced environment
  • Must be able to work independently as well as part of a collaborative team          
     
    Requirements:
    Bachelor's degree in related field, or equivalent experience
    3 or more years solid work experience in a related industry. 3 or more years’ experience in the pharmaceutical area working Medicaid Claims and the Revitas systems is highly preferred
     
     
    The Sr. Medicaid Specialist is responsible for the end-to-end Medicaid Drug Rebate process which includes validating, verifying, disputing when necessary, and remitting payment for state, SPAP, and Supplemental programs. This role will validate and analyze utilization trends against prescribed methods. The Sr. Medicaid Specialist ensures payments are submitted within aggressive deadlines.
     
    Primary responsibilities:
  • Responsible for the accurate and timely process of the Medicaid rebate invoices as well as the tracking of these payments with internal stakeholders and various state agencies while following corporate controls/approved guidelines and SOX regulations
  • Responsible for the accurate and timely process of TRICARE and Medicare Part D rebates, as well as the tracking of these payments with internal stakeholders and various federal agencies
  • Demonstrate knowledge and understanding of the laws, regulations, and policies that pertain to the organizational business unit and conforms with these laws, regulations, and policies in carrying out the accountability of the job
  • Responsible for ensuring compliance with all state and federal mandated due dates and avoiding interest penalties
  • Ability to work with large amounts of data is required; evaluate claims level detail to ensure product dispensing is aligned with Grifols set guidelines and dispute accordingly
  • Responsible for negotiating and resolving dispute resolutions with state personnel while ensuring accurate and efficient documentation of payments
  • Responsible for calculating and validating quarterly Unit Rebate Amounts (URAs) under the Medicaid Drug Rebate Program, SPAP and other government contracts
  • Responsible for coordinating rebate payments with management, Finance, and Accounts Payable
  • Development an array of corporate financial reports (GTNs, forecasts, budgets, accruals) as they relate to government markets; disseminate the report to the Government Pricing Director
  • Knowledge of working under SOPs and work instruction process is required
  • Develop and maintain strong working relationships to facilitate the exchange of key information, understand and address needs, and clarify contract requirements with internal and external customers
  • Responsible for updating the Government Pricing Director with changes to state programs and drug placements
  • Assist other team members with projects and/or reports, as needed to ensure the department achieves its goals
  • Ability to handle multiple priorities simultaneously, with strong attention to detail, while meeting strict deadlines
  • Assist in assuring compliance with all pricing and reporting requirements for Federal and State programs and as legislated by the Centers for Medicare & Medicaid Services (CMS) and Veterans Affairs (VA)
  • Responsible for system updates regarding all aspects of government contracts; collaborate with other team members on contract set up/maintenance to help ensure the accuracy of all assigned contracts, while ensuring the Medicaid processing program replicates the requirements of the executed contract
  • Responsible for the update of Standard Operating Procedures (SOPs) and work instruction documents
  • Assist in establishing processes to ensure compliance as well as analyzing the impact on the Grifols business created by these changes
  • Participate in internal and external audits, when needed, and demonstrate compliance with policies, laws, and regulations
  • Assist with requirement documentation and testing for information technology system upgrades, enhancements and patches
  • Scan historical Medicaid rebate invoices and prepare paper files to be sent to an off-site storage facility
  • Additional responsibilities/duties may be assigned to meet departmental goals
     
    Knowledge, skills & abilities:
  • Must have strong knowledge of state and federal rules and regulations that govern the Government Contracting area (Medicaid, Medicare, TRICARE, etc.)
  • Advanced knowledge in the Microsoft Office suite is required
  • Knowledge of Medicaid processing through Model N (f.k.a. Revitas) Flex MRB is preferred
  • Strong interpersonal and oral/written communication skills are required
  • Knowledge of Medicaid processing is required
  • Ability to handle multiple priorities simultaneously, with strong attention to detail, while meeting strict deadlines
  • Excellent planning and time management skills
  • Solid concept of algebraic and financial formulas
  • Ability to multi-task in a fast-paced environment
  • Must be able to work independently as well as part of a collaborative team
  • Strong analytical and project management skills, including a thorough understanding of how to interpret and use data in problem solving and process improvement
  • Health care business acumen with a comprehensive understanding of the pharmaceutical industry
     
    Requirements:
    BS/BA in Finance or Information Systems
    6 years' relevant experience
    or MBA with 2-4 years' relevant experience
     
    Work is performed in an office environment with exposure to electrical office equipment. Frequently sits for 6-8 hours per day. Frequent hand movement of both hands with the ability to make fast, simple, movements of the fingers, hands, and wrists.   Occasionally walks and stands. Occasionally bends and twists neck.  Light to moderate lifting and carrying objects with a maximum lift of 25lbs. Frequently drives to site locations with occasional travel within the United States. Able to communicate information and ideas so others will understand; with the ability to listen to and understand information and ideas presented through spoken and written words and sentences.  Interacts with others, relates sensitive information to diverse groups. Must work with diverse groups to obtain consensus on issues.
     
    EEO/Minorities/Females/Disability/Veterans

 

                

 

 

 

Location: NORTH AMERICA : USA : NC-RTP:USNC0001 - RTP NC-Headquarters 

 

Learn more about Grifols