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Claims Analyst I

Careers Integrated Resources Inc Parsippany-Troy Hills, NJ (Onsite) Contractor
Job Title: Claims Analyst I
Job Location: Parsippany, NJ ( Remote)
Job Duration: 2-3 Months (Possibilities of Extension)
Pay: $65.00 - $70.00/ hr on w2
Shift: Remote: Monday - Friday, 8:00am - 5:00pm; Hybrid workers have Tuesday and Wednesday onsite and Monday, Thursday and Friday from home.

Job 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 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.
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.
  • Perform Claim Level Detail validation.
  • Review suspect claim records and determines if record should be disputed for payment.
  • 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.
  • Complete Medicaid analyzes and documentation on assigned states/programs.
  • Communicate to manager for key findings and changes to state programs.
  • Provide backup for Medicaid team members in any necessary functions and work with team to establish best practices within Client Medicaid work environment.
  • 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.
  • Conduct initial quality check on summary data on all claim submissions to ensure rebate eligibility and data consistency.
  • Perform Claim Level Detail validation.
  • Review suspect claim records and determines if record should be disputed for payment.
  • 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.
  • Complete Medicaid analyzes and documentation on assigned states/programs.
  • Communicate to manager for key findings and changes to state programs.
Education Required:
  • Bachelor’s degree/ High school Diploma 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/product focused healthcare 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.
Core competencies:
1. 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.
2. 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.
3. 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.
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Job Snapshot

Employee Type

Contractor

Location

Parsippany-Troy Hills, NJ (Onsite)

Job Type

Other

Experience

Not Specified

Date Posted

06/10/2025

Job ID

25-48445

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