Medicaid Claims Analyst

3 weeks ago

Parsippany, United States Cynet Systems Full time
We are looking for Medicaid Claims Analyst for our client in Parsippany, NJ Job Title: Medicaid Claims Analyst Job Location: Parsippany, NJ Job Type: Contract Job Description: Pay Range: $35hr - $40hr 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 Medicaid systems and authorize transactions.
  • Document errors and perform research.
  • Conduct initial quality check on summary data on all claim submissions to ensure rebate eligibility and data consistency. 20%
  • Perform Claim Level Detail validation.
  • Review suspect claim records and determine if records should be disputed for payment 20%.
  • 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 recommendations on state disputes, apply proper amounts to be paid & ensure CMS codes are applied correctly; notify states of results/findings 20%.
  • Complete Medicaid analysis and documentation on assigned states/programs.
  • Communicate to the manager for key findings and changes to state programs 10%.
  • Provide backup for Medicaid team members in any necessary functions and work with the team to establish best practices within the Medicaid work environment 5%.
  • Work with assigned states to get a 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.
  • Document errors and perform research 5%.
  • Conduct initial quality check on summary data on all claim submissions to ensure rebate eligibility and data consistency 5%.
  • Perform Claim Level Detail validation.
  • Review suspect claim records and determine if records should be disputed for payment 5%.
  • 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 recommendations on state disputes, apply proper amounts to be paid & ensure CMS codes are applied correctly; notify states of results/findings 5%.
  • Complete Medicaid analysis and documentation on assigned states/programs.
  • Communicate to the manager for key findings and changes to state programs 5%.
Education Required:
  • Bachelor s degree or equivalent combination of experience, training and/or direct work related experience.
Experience Required:
  • Prior Medicaid Claim processing experience with a Pharmaceutical and/or med Device company , state and/or state agency.
  • As Medicaid consultant or equivalent work experience.
  • Minimum 2+ years pharmaceutical/product focused healthcare experience.
  • Medicaid Claim processing function; manipulation of large datasets, negotiation/conflict resolution.
  • System Implementation and report writing.
Knowledge, License and Certifications:
  • Knowledge of the Model N or Revitas/Flex Medicaid and/or Flex Validate system (or other comparable system) and advanced Microsoft Excel skills.
  • Familiar with CMS Medicaid rules and state specific issues.
  • Up to date knowledge on Medicaid Validation rules and issues with 340B covered entities.
  • Strong ability to organize and manipulate large volumes of data in various formats.
  • Attention to detail and high degree of accuracy in data processing and reviews.
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.
  • Coaches and counsels associates 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 sense of urgency by 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.

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