Medical Claims/Rebate Analyst II

Job Posting Title

Medical Claims/Rebate Analyst II

Agency

807 HEALTH CARE AUTHORITY

Supervisory Organization

Pharmacy

Job Posting End Date (Continuous if Blank)

February 14, 2025

Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.

Estimated Appointment End Date (Continuous if Blank)

Full/Part-Time

Full time

Job Type

Regular

Compensation

$22.81875/hourly

Job Description

Agency/Division Information

The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agency’s core values include passion for purpose, trust and transparency, empowerment and accountability, best in class and outcome-driven, and servant leadership. As part of the interview process, candidates may be required to attend an in-person interview at our Oklahoma City office.

Position Purpose

The Medical Claims/Rebate Analyst II ensures accurate and efficient processing of drug rebate data, reconciliation of transactions, and resolution of billing and coding issues. This role supports the Medicaid division by analyzing invoice data, maintaining records, responding to inquiries, and improving claims processing procedures in compliance with agency policies and federal regulations. The position contributes to the financial and operational success of the drug rebate unit through detailed analysis, effective communication, and collaboration with stakeholders.

Principle Activities

• Accurately post drug rebate receipt data for payments made to quarterly invoices sent to drug manufacturers and ensuring interest is applied on late paid quarters.

• Independently analyze drug rebate invoice data to ensure accuracy and make corrections to invoices and claims based on review of pharmacy and medical billing. This includes review of payment documentation, communication with drug manufacturers regarding disputes, communication with providers regarding incorrectly billed claims and review of rebate data provided by CMS. 

• Respond to telephone or email inquiries regarding policy, drug rebate protocol, and fulfill requests for data from CMS, drug manufacturers and other appropriate individuals.

• Create and maintain records and data pertaining to the drug rebate unit.

• Perform internal and external special projects as required.

• Other duties as assigned.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Knowledge, Skills, Abilities and Competencies

The Medical Claims/Rebate Analyst II role requires strong analytical skills to accurately process and reconcile rebate data, proficiency in interpreting complex billing and coding information, and the ability to collaborate with multiple stakeholders, including drug manufacturers and providers. It also demands a thorough understanding of agency policies, federal regulations, and effective communication skills to address inquiries and resolve disputes. Relevant Korn Ferry competencies include Manages Complexity, for analyzing detailed rebate data and addressing disputes, and Ensures Accountability, for maintaining accurate records and ensuring compliance with policies and procedures.

**To be considered for this position your application must include a resume/CV with complete work and education history.**

Education and/or Experience

• Associate’s degree AND

• 2 years of experience in a health care field, such as public or community health, health care administration, or closely related field. OR

• An equivalent combination of education and experience.

Preference may be given to candidates with

• Certifications in any of the following areas: Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) for expertise in medical billing and coding.

• Certified Healthcare Financial Professional (CHFP) for a deeper understanding of healthcare finance and operations.

• Certified Public Accountant (CPA) or equivalent certification for financial and reconciliation skills.

• Data analytics certifications such as Certified Analytics Professional (CAP) or relevant data-related credentials.

• A healthcare-related license, such as a Licensed Practical Nurse (LPN) or similar, to demonstrate familiarity with healthcare terminology and processes (if applicable).

• Hands-on experience in medical claims processing, pharmaceutical rebate management, or Medicaid program operations.

• Familiarity with CMS (Centers for Medicare & Medicaid Services) drug rebate protocols and policies.

• Proficiency in relevant software such as Oracle, SQL, or other database management systems.

• Prior experience in roles requiring HIPAA compliance.

Physical Demands

• Must be able to remain sitting for prolonged periods at a desk and working on a computer.

• Must be able to move or lift up to 15 pounds at various times.

Work Environment

The office work environment includes regular exposure to general office equipment such as computer equipment, phones, and copy machines. 

Why You’ll Love Working Here

At the Oklahoma Health Care Authority (OHCA), we’re proud to create a workplace where employees thrive. Named a Top Workplace in Oklahoma for four consecutive years, this achievement reflects the dedication and collaborative spirit of our incredible team. Here’s what we offer to support employees and their family:

• Generous state-paid benefit allowance to offset insurance premiums.

• A wide selection of top-tier health insurance plans.

• Optional flexible spending accounts for health care or dependent care expenses.

• Employee Assistance Program (EAP) offering confidential support.

• Wellness benefits, including an on-site gym and fitness center discounts.

• 11 paid holidays annually.

• 15 vacation days and 15 sick days in your first year.

• Retirement Savings Plan with substantial employer contributions.

• Longevity Bonus to reward years of service.

• Public Service Loan Forgiveness eligibility and reimbursement for educational expenses.

• Professional development training opportunities, including CEU support.

Accommodation Statement:

The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate.  All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at 405-522-7335. 

Notice to applicants:

Please add [email protected]  to the address book or “safe-senders” list in your email.  All correspondence will come from this address.  Be sure to check your junk folder.  If you have questions about the status of your application, you can contact the HR team at 405-522-7093.

Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.

Current State of Oklahoma employees must apply for open positions internally through Workday Jobs Hub. 

Equal Opportunity Employment

The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability.

Current active State of Oklahoma employees must apply for open positions internally through the Workday Jobs Hub.