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Pricing & Contract Analyst I in Horsham, PA at Integrated Resources, Inc

Date Posted: 3/4/2019

Job Snapshot

Job Description


Medicaid Claim Analyst Contracting Position


Position Summary:

Administers the receipt, validation, dispute and payment of the rebate claims for both brand and generic NDCS from States.
Processes each claim in accordance with CMS guidelines and Client contract terms and conditions with the state. Research and resolve dispute resolution timely.
Performs special analyses on claim data as requested.

Essential Duties & Responsibilities Percentage of Time

1. Download and organize Medicaid Summary invoice, summary data file and Claim Level Invoice using RPA tool. Upload data into Model N systems (Flex and Validata) 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.
40%
2. Perform Claim Level Detail validation. Review suspect claim records and determines if record should be disputed for payment.
20%

3. 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.
20%
4. Complete Medicaid analyzes and documentation on assigned state/programs. Communicate to managers for key findings.
10%
5. Provide backup for Medicaid team members in any necessary functions and work with team to establish best practices within Client Medicaid work environment.
5%
6. Provide support on ad hoc analytics and process improvement projects 5%




Position Requirements:
Education Required:

Bachelor's Degree Required


Experience Required: Minimum of 1-2 years of hands on Medicaid Claim processing experience with Pharmaceutical company , state and/or state agency, pharmaceutical consulting company


Specialized or Technical Knowledge, License, Certifications needed: Revitas, Model N, Validata, Oracle, SAP, Business Intelligence, Oracle Discoverer, Tableau preferred

Company/Industry Related Knowledge: Medicaid, Government Pricing, 340B and Rebate; pharmaceutical industry experience/knowledge preferred.

Job Competencies :
Excellence in Execution: Demonstrates initiative and creates an appropriate level of urgency to meet department objectives and quarterly deadlines. Strong ability to organize and manipulate large volume of data in various formats.