Specialist, Government and 340B Operations Full-time Job

Responsibilities

•This position will support Government and 340B operations and processes

•Government operations responsibilities include primary responsibility for Medicaid claim review and payment reconciliation

•Support invoice dispute resolution with states and other stakeholders

•340B operations responsibilities include support of rebate scrubbing and GTN recovery efforts

•Perform quarterly Medicaid claim review including quarterly trend review, validation assessment, check/payment reconciliation

•Ensure back-up documentation is accurate and sent to states/programs in a timely manner

•Reconcile checks/payments with large amounts of data

•Resolve credit balance issues

•Manage Medicaid mailbox as the primary contact responding to state inquiries

•Additional responsibilities may include, but are not limited to, the processing of quarterly Tricare rebate claims, preparation of the Industrial Funding Fee (IFF), assistance with 340B refunds, and support of audit, ad-hoc, and integration requests

•Review Outstanding Dispute Report and prioritize dispute proposals/settlements

•Work closely with states and utilize claim level detail (CLD) to resolve disputed Medicaid claims

•Work with outside vendor to manage State Disputes and ensure released reserves are accurately reflected in their internal system

•Track and provide reporting for Medicaid disputes filed with certain states requiring engagement with 340B covered entities

•Assist with audit request related to Medicaid rebate payments

•Work with outside vendor to scrub Managed Care rebates in SQL Developer and assist with any questions

•Gather and load data needed for scrubbing rebates

•Communicate with outside vendor and internal team on status of rebate scrubbing

•Work closely with various stakeholders and functions

•Demonstrate compliance, company values and required competencies on a consistent basis

•Perform other related duties as requested