What are the responsibilities and job description for the Medicaid Claims Analyst I position at LanceSoft, Inc.?
Title: Medicaid Claims Analyst
Location: 400 Interpace Parkway, Parsippany, NJ 07054 (Hybrid)
Duration: 8-9 Months
Shift:
Education Required:
Core competencies:
Analysis
LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.
EEO Employer
LanceSoft is a certified Minority Business Enterprise (MBE) and an equal opportunity employer. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. LanceSoft makes hiring decisions based solely on qualifications, merit, and business needs at the time
Location: 400 Interpace Parkway, Parsippany, NJ 07054 (Hybrid)
Duration: 8-9 Months
Shift:
- Monday - Friday 8:00am - 5:00pm - Hybrid Only - Tuesday and Wednesday onsite and Monday, Thursday and Friday.
- Contingent with the possibility to extend
- Medicaid rebate experience in pharm enviornment.
- 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.
- 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 Client guidelines and Client 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.
- 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 Client 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 Client 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 Client 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.
- 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.
- 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 Client 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.
- 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.
- Coaches and counsels associates to improve performance toward individual and department goals
- Continuously expands technical and personal skills and business knowledge
- 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
- Committed to meeting deadlines
- Demonstrates sense of urgency by effectively prioritizing workload according to organizational needs
- Demonstrates the ability to manage multiple priorities
- Possesses solid accounting skills particularly around accuracy and internal controls
- Demonstrates advanced data management and Excel skills
- Understands fundamental mechanics of rebate systems
Employee Benefits:
At LanceSoft, full time regular employees who work a minimum of 30 hours a week or more are entitled to the following benefits. (To be bought) - Four options of Medical Insurance
- Dental and Vision Insurance
- 401k Contributions
- Critical Illness Insurance
- Voluntary Permanent Life Insurance
- Accident Insurance
- Other Employee Perks
LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.
EEO Employer
LanceSoft is a certified Minority Business Enterprise (MBE) and an equal opportunity employer. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. LanceSoft makes hiring decisions based solely on qualifications, merit, and business needs at the time
Salary : $40
