Medicaid Claims Specialist

2 weeks ago


Parsippany, New Jersey, United States Cynet Systems Full time
Job Description

We are seeking a Medicaid Claims Specialist to join our team at Cynet Systems.

Position Overview:

Job Type: Contract

Compensation: $35/hr - $40/hr

Key Responsibilities:

  • Input data into Medicaid systems and authorize transactions.
  • Identify and document discrepancies while conducting thorough research.
  • Perform initial quality assessments on summary data for all claim submissions to verify rebate eligibility and data accuracy.
  • Execute Claim Level Detail validation.
  • Support Medicaid team members in various functions and collaborate to establish best practices within the Medicaid environment.
  • Coordinate with assigned states to obtain Medicaid Summary invoices, summary data files, and Claim Level Invoices quarterly, ensuring completeness of received information.
  • Upload data into Model N / Medicaid systems and authorize transactions.
  • Review questionable claim records to determine if disputes for payment are warranted.
  • Work independently to recommend actions on state disputes, ensuring accurate payment amounts and correct application of CMS codes.
  • Conduct Medicaid analyses and documentation for assigned states/programs.
  • Communicate key findings and changes to state programs to management.

Education Requirements:

  • Bachelor's degree or a combination of relevant experience and training.

Experience Requirements:

  • Previous experience in Medicaid Claim processing within the pharmaceutical or medical device sectors, or as a Medicaid consultant.

Preferred Experience:

  • At least 2 years of experience in healthcare focused on pharmaceuticals/products, specifically in Medicaid Claim processing, large dataset manipulation, and negotiation/conflict resolution.
  • Experience with system implementation and report generation.

Technical Skills and Certifications:

  • Familiarity with Model N or Revitas/Flex Medicaid systems and advanced Microsoft Excel skills.
  • Knowledge of CMS Medicaid regulations and state-specific issues.
  • Current understanding of Medicaid validation rules and challenges related to 340B covered entities.
  • Strong organizational skills for managing and manipulating large volumes of data.
  • High attention to detail and accuracy in data processing and review.

Industry Knowledge:

  • Experience or knowledge in Medicaid, Government Pricing, and Rebate within the pharmaceutical industry is preferred.

Core Competencies:

  • Analytical skills to resolve complex problems and improve processes.
  • Ability to coach and develop team members to achieve individual and departmental goals.
  • Commitment to continuous personal and technical skill development.

Interpersonal Skills:

  • Ability to build strong relationships with internal and external stakeholders.
  • Reputation for credibility, trustworthiness, and fairness.
  • Integrity in actions and decisions for the benefit of the company.

Planning and Organization:

  • Strong commitment to meeting deadlines and managing multiple priorities effectively.

Technical Proficiency:

  • Solid accounting skills with a focus on accuracy and internal controls.
  • Advanced data management and Excel capabilities.
  • Understanding of rebate system mechanics.

For more information about our open positions, please visit our career site.



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