Medicaid Claims Analyst

Position Summary:The Medicaid Claims Analyst is responsible for the 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 assists in resolving dispute resolution, weekly pay run activities, SOX audits, system upgrade/implementation, and ad hoc analysisMust Haves:Prior Medicaid Claim processing experience with a Pharmaceutical and/or medical Device company, state, and/or state agency or as a Medicaid consultant or equivalent work experienceMinimum 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 advanced Microsoft Excel skills.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 the ability to work independently and make recommendations on state disputes, apply proper amounts to be paid & ensure CMS codes are applied correctly; notify states of results/findingsStrong ability to organize and manipulate a large volume of data in various formats. Attention to detail and a high degree of accuracy in data processing and reviews.