Sr. Analyst, Medicaid & Government Rebate Programs



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See open jobs at Kalderos.
Chicago, IL, USA
Posted on Friday, February 2, 2024

About Us

At Kalderos, we are building unifying technologies that bring transparency, trust, and equity to the entire healthcare community. Our success is measured when we can empower all of healthcare to focus more on improving the health of people.

We thrive on innovation, feedback, and moving the needle forward. In order to disrupt an industry, we continue to employ passionate individuals who never settle for status quo.

That’s where you come in!

This is a unique opportunity for a Subject Matter Expert to liaise between Kalderos and one of our enterprise clients, Bayer. You'll bring your manager-level Medicaid experience to embed yourself with our client and augment the services Kalderos provides to Bayer's Medicaid claims and adjudication team, providing operational support and expertise.

*This is a full-time opportunity with Kalderos, initially as a 9 month contract, with the opportunity to extend or move into a new role at Kalderos. This role will either be based in Chicago, IL or Whippany, NJ, with monthly travel between the two locations.

What You'll Do:

  • Claims Processing: Assist Bayer CATI team with the processing of Kalderos disputes, including managing assigned states end-to-end by entering claims into Bayer's Medicaid claims adjudication system (Vistex), 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 Bayer’s Medicaid rebate analysts
  • 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 Team Lead, which will ladder up to status updates to Bayer
  • 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
  • Provide insight with in-depth analytics and reporting to internal and external parties

What You'll Bring:

  • 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


Highlighted Company Perks and Benefits

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

What It’s Like Working Here

  • We thrive on collaboration, because we believe that all voices matter and we can only put our best work into the world when we work together to solve problems.
  • We empower each other and believe in ensuring all voices are heard.
  • We know the importance of feedback in individual and organizational growth and development, which is why we've embedded it into our practice and culture.
  • We’re curious and go deep. Our slack channel is filled throughout the day with insightful articles, discussions around our industry, healthcare, and our book club is always bursting with questions.

To learn more: https://www.kalderos.com/company/culture

We know that job postings can be intimidating, and research shows that while men apply to jobs when they meet an average of 60% of the criteria, women and other marginalized folks tend to only apply when they check every box. We encourage you to apply if you think you may be a fit and give us both a chance to find out!

Kalderos is proud to be an equal opportunity workplace. We are committed to equal opportunity regardless of race, color, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, or veteran status.

Kalderos participates in E-Verify.

This job is no longer accepting applications

See open jobs at Kalderos.