Medicaid Claims Analyst

Parsippany, NJ

Posted: 07/29/2022 Job Number: 21294370

Job Description

MEDICAID CLAIMS ANALYST
PARSIPPANY, NJ
Hybrid role.
Flexible work schedule: 8 hrs. M-F, between 7-9am 4-6pm; Remote Monday and Friday).

Project Description:
  • 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.
  • Analyst is accountable for submitting payments within deadlines and in compliance with CMS guidelines and Client's 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.
  • 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.
  • Perform Claim Level Detail validation.
  • Review suspect claim records and determines 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 analyzes 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 the Client's Medicaid work environment.
  • 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.
  • 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.
  • Review suspect claim records and determines 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 analyzes and documentation on assigned states/programs.
  • Communicate to manager for key findings and changes to state programs.

Required Skills:
  • Bachelor's degree or equivalent combination of experience, training and/or direct work-related experience.
  • 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.
  • Minimum 2+ years pharmaceutical experience; Medicaid Claim processing function; manipulation of large datasets, negotiation/conflict resolution.
  • System Implementation and report writing.
  • Specialized or Technical Knowledge, License, Certifications needed: Knowledge of the Model N or Revitas/Flex Medicaid and/or Flex Validata system (or other comparable system) and advance 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 volume 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 prefer.

This 6+ month position starts ASAP.

Please E-MAIL your resume (attachment to email) with rate and availability to Vic: vic@alphaconsulting.Com

ALPHA'S REQUIREMENT #22-02294
MUST BE ELIGIBLE TO WORK IN THE U.S. AS AN HOURLY W2 EMPLOYEE

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Vic Buch

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