Medicaid Claims Analyst Job Williamstown New Jersey USA,Healthcare

Location: Williamstown

Job 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 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 recommendations 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 the 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 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 recommendations 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 the manager for key findings and changes to state programs. 5%

Skills

Pharmaceutical experience is a must! The 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.
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.

Education/Experience

Bachelor’s degree/ High school Diploma or equivalent combination of experience, training and/or…