Medicaid Claims Analyst

We are looking for Medicaid Claims Analyst for our client in

Parsippany, NJ Job Title:

Medicaid Claims Analyst Job Location:

Parsippany, NJ Job Type:

Contract Job Overview:

Pay Range:

$55hr - $60hr Responsible for processing, validating, analyzing, and resolving Medicaid claims while ensuring compliance with Medicaid regulations, rebate systems, and data accuracy standards.

Experience:

Prior Medicaid claim processing experience with a pharmaceutical, medical device company, state agency, Medicaid consulting organization, or equivalent work experience. Minimum 2+ years of pharmaceutical or healthcare industry experience preferred. Experience with Medicaid claim processing functions and large dataset management. Experience with negotiation and conflict resolution preferred. Experience with system implementation and report writing preferred.

Responsibilities:

Work with assigned states to obtain Medicaid Summary invoices, summary data files, and Claim Level Invoices each quarter. Review received information to ensure completeness and accuracy. Upload data into Medicaid systems and authorize transactions. Document errors, conduct research, and resolve discrepancies. Perform quality checks on claim submissions to ensure rebate eligibility and data consistency. Conduct Claim Level Detail validation and review suspect claim records. Determine if claim records should be disputed for payment and recommend payment resolutions. Resolve disputes related to historical outstanding utilization submitted with Medicaid claims. Apply proper payment amounts and ensure CMS codes are correctly assigned. Notify states regarding findings and claim resolutions. Complete Medicaid analysis and maintain documentation for assigned states and programs. Communicate key findings and program changes to management. Provide backup support for Medicaid team members and contribute to establishing best practices. Analyze processes and systems to improve operational efficiency through standardization and automation. Build and maintain strong relationships with internal and external stakeholders. Manage multiple priorities while meeting deadlines and organizational objectives.

Should Have:

Strong analytical and data interpretation skills. Strong organizational and prioritization skills. High attention to detail and accuracy in data processing. Ability to work independently and make recommendations on disputes and payment resolutions. Strong interpersonal and communication skills. Ability to coach and collaborate effectively within a team environment.

Skills:

Knowledge of Model N, Revitas/Flex Medicaid, Flex Validata, or similar Medicaid systems. Advanced Microsoft Excel and data management skills. Familiarity with CMS Medicaid rules and state-specific Medicaid regulations. Knowledge of Medicaid validation rules and 340B covered entity issues. Strong accounting and internal control knowledge. Data analysis and reporting skills. Understanding of rebate systems and government pricing processes.

Qualification And Education:

Bachelor s degree or equivalent combination of experience, training, and related work experience. Medicaid, government pricing, and pharmaceutical industry knowledge preferred.