Medicaid Analyst
Company: Stefanini
Location: Parsippany
Posted on: June 25, 2022
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Job Description:
Stefanini Group is hiring!
Exciting opportunity awaits, let us help you get started!
Click Apply now or you may call: (248) 936-0653 /
email:Rogelio.Agas@stefanini.com for faster processing!
Open to W2 candidates only!
*** EXCEL Assessment required
***Model N or Flex Revitas - Revenue Management System EXP
*** Training 1-2 weeks onsite
***Hybrid schedule-currently in the office 3x a week on Mondays,
Wednesdays and Thursdays (can be flexible)
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 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 company
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 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 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
Keywords: Stefanini, New York , Medicaid Analyst, Professions , Parsippany, New York
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here to apply!
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