17 days old

Medicaid Claims Analyst

Parsippany, NJ 07054
Company Info

 

Teva is a global pharmaceutical leader and the world's largest generic medicines producer, committed to improving health and increasing access to quality health solutions worldwide. Our employees are at the core of our success, with colleagues in over 80 countries delivering the world's largest medicine cabinet to 200 million people every day. We offer a uniquely diverse portfolio of products and solutions for patients and we've built a promising pipeline centered around our core therapeutic areas.  We are continually developing patient-centric solutions and significantly growing both our generic and specialty medicines business through investment in research and development, marketing, business development and innovation. This is how we improve health and enable people to live better, healthier lives. Join us on our journey of growth!

Job Description


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:                                                                                                                                                   

 

  • 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 20% of the time
  • 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 20% of the time
  • 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% of the time
  • Complete Medicaid analyzes and documentation on assigned states/programs. Communicate to manager for key findings and changes to state programs 10% of the time
  • Provide backup for Medicaid team members in any necessary functions and work with team to establish best practices within Teva Medicaid work environment 5% of the 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 Model N / Medicaid systems and authorize transactions. Document errors and perform research 5% of the time
  • Conduct initial quality check on summary data on all claim submissions to ensure rebate  eligibility and data consistency 5% of the time
  • Perform Claim Level Detail validation. Review suspect claim records and determines if record should be disputed for payment 5% of the time
  • 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 5% of the time
  • Complete Medicaid analyzes and documentation on assigned states/programs. Communicate to manager for key findings and changes to state programs  5% of the time

 

Qualifications

 

Position Requirements:

 

Education Required: 

  • Bachelors degree and/or equivalent combination of education, training and/or direct work related experience
  • MBA preferred

 

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: 

  • Pharmaceutical Industry and/or Med Device experience; Medicaid Claim processing function; manipulation of large datasets, negotiation/conflict resolution.  System Implementation and report writing

 

Specialized or Technical Knowledge, License, Certifications needed: 

  • Minimum 3+ years 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
     

 

 

Function
Marketing
Sub Function
Managed Care Administration
Reports To
In process of validation
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Categories

Posted: 2020-01-30 Expires: 2020-03-11

Join us at the forefront of pharmaceutical research and production. With state-of-the-art facilities, highly skilled colleagues, and a high-powered organizational culture, Teva offers you countless possibilities to make a real difference in people's lives and add value to your career.

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Medicaid Claims Analyst

Teva Pharmaceuticals
Parsippany, NJ 07054

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