Medicaid Claims Analyst (Bolingbrook)

AbbVie in Bolingbrook, IL

  • Industry: Financial Services - Insurance - Actuary
  • Type: Full Time
  • $110,710.00 - 179,660.00
position filled
The US federal and state governments are significant customers of AbbVie ensuring patients covered under their numerous healthcare programs have access to our medicines. Medicaid is one of the largest of these programs. AbbVie contributes to the success of this program by providing discounted prices on our products. Incumbent will analyze, dispute and process a large volume of quarterly rebate claims within required timelines.

Key Responsibilities Include:
  • Administer statutory and contractual state rebate claims, ensuring timely and accurate payment.
  • Proactively communicate with state representatives to adjust disputable claims prior to claims payment and avoid disputes.
    Analyze detailed claim detail from states based on medical prescribing and billing utilization guidelines of the product.
    Identify trends and anomalies and be able to articulate them to various levels of management
  • Develop relationships with state contacts and support multiple data and compliance requests from the states.
  • Develop knowledge of Medicaid and contract rebate formulas and legislation, Model N, product prescribing information and state program information.
  • A dd / Update Medicaid programs in Model N, as required.

Ability to work productively within a team environment and perform duties independently or with a low level of supervision. The incumbent is responsible for the accurate and timely payment of statutory and contracted rebates to state Medicaid agencies. The incumbent is accountable for functions that have a direct impact on rebate transactions in excess of $2 billion annually. He/she is expected to identify opportunities for productivity and process improvements.

  • BA/BS, or equivalent experience required
  • 2+ years business experience, preferably with a concentration in contracting, and Medicaid related activities or financial analysis
  • Ability to work productively within a team environment and perform duties independently or with moderate supervision.
  • Must have strong oral and written communication skills.
  • Problem Solving and integrity are key competencies of this position.
  • Must be able to apply sound judgment to the analysis of Medicaid Rebates, determining appropriate payments to the State Agencies and consult with management to determine reasonableness when necessary.
  • Sound organizational skills with a high degree of follow up & follow through are requirements within this position.
  • Must be proficient in Microsoft Word, Excel (text import, pivot tables, reference matching).
  • Previous experience with Revenue Management software (i.e. Model N, Revitas, etc is helpful.

Associated topics: actuarial, actuarial assistant, actuarial director, actuary, actuary consultant, cost, investment actuary, probability, retirement actuary, risk

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