Medicaid Claims Analyst

7 days ago

Parsippany, United States Cognizant Full time
About Us:

Cognizant (Nasdaq: CTSH) engineers’ modern businesses. We help our clients modernize technology, reimagine processes and transform experiences so they can stay ahead in our fast-changing world. Together, we're improving everyday life. See how at www.cognizant.com

The role is encouraged to drive technology discussions and analyze the current landscape for gaps in addressing business needs. Cognizant needs a motivated individual to challenge the status quo and provide thought leadership/standard methodologies to improve our current services and technologies.

Role: Medicaid Claims Analyst (Must have experience in Model-N-Rec-Medicaid)

The Medicaid Claims Analyst is responsible for Medicaid Drug Rebate process which includes validating, verifying, disputing when necessary, and remitting payment for assigned state Medicaid agencies, SPAPs and Supplemental Rebates. The Analyst is accountable for submitting payments within deadlines and in compliance with CMS guidelines and rebate contract terms.

This position also provides assistance in resolving dispute resolution, weekly pay run activities, SOX audits, system upgrade/implementation and ad hoc analysis. Medicaid rebate experience in pharma environment.

Responsibilities:
  • Work with assigned states to get Medicaid Summary invoice, summary data file and Claim Level Invoice each quarter and review to ensure completeness of information received.
  • Upload data into Model N / Medicaid systems and authorize transactions, as well as document errors and perform research.
  • Conduct initial quality check on summary data on all claim submissions to ensure rebate eligibility and data consistency.
  • Perform Claim Level Detail validation and review suspect claim records and determine if record should be disputed for payment.
  • Resolve disputes and propose recommended amounts to be paid for historical outstanding utilization that is routinely submitted with Medicaid claims.
  • Must have ability to work independently and make recommendation on state disputes, apply proper amounts to be paid & ensure CMS codes are applied correctly; notify states of results/findings.
  • Complete Medicaid analyze and documentation on assigned states/programs.
  • Communicate to manager for key findings and changes to state programs.
  • Provide backup for Medicaid team members in any necessary functions and work with team to establish best practices within Medicaid work environment.
Qualifications
  • Minimum 2+ years pharmaceutical/product focused healthcare experience.
  • Must Have Knowledge of the Model N.
  • Knowledge of Revitas/Flex Medicaid and/or Flex Validate system (or other comparable system) and advanced Microsoft Excel skills.
  • Bachelor’s degree or equivalent combination of experience, training, and/or direct work-related experience.
  • Medicaid Claim processing function; manipulation of large datasets, negotiation/conflict resolution. System Implementation and report writing.
  • Prior Medicaid Claim processing experience with a Pharmaceutical and/or med Device company, state and/or state agency or as Medicaid consultant or equivalent work experience.
  • Strong ability to organize and manipulate large volume of data in various formats, as well as attention to detail and high degree of accuracy in data processing and reviews.
  • Familiar with CMS Medicaid rules and state specific issues. Up to date knowledge on Medicaid Validation rules and issues with 340B covered entities.
  • Company/Industry Related Knowledge: Medicaid, Government Pricing and Rebate Pharmaceutical industry experience/knowledge preferred.
Core competencies Analysis
  • Uses good analytical and data interpretation skills to analyze and resolve complex problems.
  • Analyzes processes and systems to improve efficiency and effectiveness through standardization, simplification, and automation.
Developing Self and Others
  • Coaches and counsels associate to improve performance toward individual and department goals.
  • Continuously expands technical and personal skills and business knowledge.
Interpersonal Ability
  • Develops and fosters strong relationships with internal and external clients.
  • Builds reputation for being credible, trustworthy, and fair.
  • Displays high level of integrity by doing what is right for the company.
  • Demonstrates administrative value to shared service customers.
Planning and Organization
  • Committed to meeting deadlines.
  • Demonstrates effectively prioritizing workload according to organizational needs
  • Demonstrates the ability to manage multiple priorities
Technical skills
  • Possesses solid accounting skills particularly around accuracy and internal controls
  • Demonstrates advanced data management and Excel skills
  • Understands fundamental mechanics of rebate systems

Salary and Other Compensation:

The annual salary for this position depends on experience and other qualifications of the successful candidate.

Benefits: Cognizant offers the following benefits for this position, subject to applicable eligibility requirements:

  • Medical/Dental/Vision/Life Insurance
  • Paid holidays plus Paid Time Off
  • 401(k) plan and contributions
  • Long-term/Short-term Disability
  • Paid Parental Leave
  • Employee Stock Purchase Plan
Disclaimer:

The salary, other compensation, and benefits information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law.

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