Teva Pharmaceuticals

Medicaid Claims Analyst

Teva Pharmaceuticals

full-time

Posted on:

Location Type: Hybrid

Location: Parsippany • New Jersey, Pennsylvania • 🇺🇸 United States

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Salary

💰 $70,000 - $95,000 per year

Job Level

JuniorMid-Level

About the role

  • 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.
  • Complete Medicaid analyzes and documentation on assigned states/programs. Communicate to manager for key findings and changes to state programs.

Requirements

  • Education Required: High School Diploma required. Bachelor’s degree 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: Minimum of 2+ years pharmaceutical/product focused healthcare experience; Medicaid Claim processing function; manipulation of large datasets, negotiation/conflict resolution.
  • 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.
Benefits
  • Comprehensive Health Insurance: Medical, Dental, Vision, and Prescription coverage starting on the first day of employment, providing the employee enrolls.
  • Retirement Savings: 401(k) with employer match, up to 6% and an annual 3.75% Defined Contribution to the 401k plan.
  • Time Off: Paid Time Off including vacation, sick/safe time, caretaker time and holidays.
  • Life and Disability Protection: Company paid Life and Disability insurance.
  • The total compensation package for this position may also include other elements, including a sign-on bonus, restricted stock units, and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard skills
Medicaid Claim processingdata manipulationdata validationdata analysisnegotiationconflict resolutionMicrosoft ExcelModel NRevitasFlex Validata
Soft skills
attention to detailorganizational skillscommunication skills