Vacancy expired!
Stefanini Group is hiring! Exciting opportunity awaits, let us help you get started! Click Apply now or you may call: / email: Cathryn. for faster processing! Open to W2 candidates only!
What You'll Do: 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. Perform Claim Level Detail validation. Review suspect claim records and determines if record should be disputed for payment.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.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.Conduct initial quality check on summary data on all claim submissions to ensure rebate eligibility and data consistency. Qualifications: Education Required: Bachelor's degree or equivalent combination of experience, training and/or direct work related experience. 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 experienceMinimum 2+ years pharmaceutical experience; Medicaid Claim processing function; manipulation of large datasets, negotiation/conflict resolution. System Implementation and report writing.Company/Industry Related Knowledge: Medicaid, Government Pricing and Rebate Pharmaceutical industry experience/knowledge preferred.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.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.Vacancy expired!