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Grifols Shared Services North America, Inc Medicaid Contracting Specialist in RTP, North Carolina


The Medicaid Contracting 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 experience3 or more years solid work experience in related industryMay require more than 40-hour work week at timesWork 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. Occasionally bends and twists neck and waist. Light to moderate lifting and carrying objects with a maximum lift of 25lbs. Drives: varies may or may be required to 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. Frequently performs tasks by following a set of written or oral instructions/procedures.EEO/Minorities/Females/Disability/Veterans #SMF

Req ID: 137979