Job Description

Job Description

We are looking for Claims Analyst for our client in Parsippany, NJ

Job Title: Claims Analyst

Job Location: Parsippany, NJ

Job Type: Contract

Job Description:

Pay Range: $35hr - $40hr

Responsibilities:

• 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.
• 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.
• Review suspect claim records and determines if record should be disputed for payment. 5%
• 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%

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 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.

Technical Knowledge, License and Certifications:

• 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.

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.

Company Description

visit our career site to see all open positions @ http://jobs.cynetsystems.com

Company Description

visit our career site to see all open positions @ http://jobs.cynetsystems.com