Claims Analyst I

Description

This is now for 3 open positions!

Title: Medicaid Claims Analyst

Pay: Confidential - 70.00 based on experience. List the pay rate on the resume.

Bill: Confidential - Confidential

Duration of Contingent Assignment: 90 days

Shift: Remote (If person is local then they would be expected to come into the office Parsippany)

Monday Friday 8:00am 5:00pm.

Hybrid workers have Tuesday and Wednesday onsite and Monday Thursday and Friday from home.

Remote workers are fully remote.

Temp to Perm: Contingent only at this time with the chance of the contingent assignment extending.

Screenings:

Background - Basic Background

Drug - 12 Panel

Core Essential Skill sets:

Pharmaceutical experience is a must! Candidate has to quickly join in and start.

- Medicaid rebate experience in pharm environment.

- 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/product focused healthcare experience; Medicaid Claim processing function; manipulation of large datasets negotiation/conflict resolution. System Implementation and report writing.

- Revitas/Flex Medicaid and advance Microsoft Excel skills.

- 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.

Position Summary:

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 Teva 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.


Essential Duties & Responsibilities Percentage of Time

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 determines if record 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 recommendation on state disputes apply proper amounts to be paid & ensure CMS codes are applied correctly; notify states of results/findings.

20%

Complete Medicaid analyzes and documentation on assigned states/programs. Communicate to manager for key findings and changes to state programs.

10%

Provide backup for Medicaid team members in any necessary functions and work with team to establish best practices within Teva Medicaid work environment.

5%

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 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 determines if record 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 recommendation on state disputes apply proper amounts to be paid & ensure CMS codes are applied correctly; notify states of results/findings. 5%


Complete Medicaid analyzes and documentation on assigned states/programs. Communicate to manager for key findings and changes to state programs. 5%

Position Requirements

Education Required:

Bachelor s degree/ High school Diploma 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 or as Medicaid consultant or equivalent work experience

Experience Preferred: Minimum 2 years pharmaceutical/product focused healthcare 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.


Travel Requirements: Minimal






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 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