Project Manager, Medicaid & Government Rebate Analyst

April 19

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Kalderos

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Redefining how the business of healthcare performs

Technology • Healthcare • Pharmacuticals • 340B Drug Discount Program • Medicaid

51 - 200

💰 $14.9M Venture Round on 2022-09

Description

• Claims Processing: Assist with the processing of Kalderos disputes, including managing assigned states end-to-end by entering claims into Medicaid claims adjudication systems, adjudicating claims, generating ROSI/PQAS, and performing data reconciliations with the states, including non-compliant claims identified by Kalderos • Medicaid Disputes Support: Following the resolution of Kalderos’ disputes with the states, enter the revised payable units to generate the relevant CMS-304a Prior Quarter Adjustment Statements (“PQAS”) for payment processing • Claims Management/Review: Review claims that are adjudicated by Medicaid rebate analysts • Reporting: Provide insight with in-depth analytics and reporting to internal and external parties • Training: Identify opportunities to incorporate Medicaid best practices from a process perspective and provide ongoing training/ reinforcement to team members • Internal Coordination: Collaborate with and participate in a regular cadence of status check-ins with Kalderos’ Customer Success and our customers • Cultivate, develop, and maintain productive and valuable working relationships with State Medicaid personnel and other key stakeholders • Provide subject expertise and operational support for federal, state & supplemental rebate programs

Requirements

• Manager-level experience with Medicaid • Customer service/claims processing experience • Outstanding attention to detail and adaptability to deliver world class results across a complex network of partners, providers and stakeholders • Ability to identify areas for process and systems innovation and implement change that will enhance the overall effectiveness of the team • Strong mathematical and analytical skills, along with demonstrated ability to prioritize multiple tasks simultaneously while meeting deadlines • Advanced Microsoft Office and Google Suite skills • Must be able to work in a collaborative team environment • Must be able to present complex information clearly and with confidence • Excellent written and verbal communication skills, capable of effectively interfacing with all levels in the company and also with external stakeholders • Demonstrated proficiency in and specific knowledge and experience within US healthcare industry, Federal and State Government program administration (Medicare, Medicaid, 340B, Orphan Drug, etc), and managed healthcare in US • Prior experience in SAP Vistex, Model N or other contract administration tool supporting rebates in US Healthcare industry highly preferably

Benefits

• Medical, Dental, and Vision benefits • 401k with company match • Flexible PTO with a 10 day minimum • Opportunity for growth • Mobile & Wifi Reimbursement • Commuter Reimbursement • Continuing education reimbursement • Donation matching for charitable contributions • Travel reimbursement for healthcare services not available near your home • New employee home office setup reimbursement