Job Title: Medicaid Claims Analyst

Job Description

The Medicaid Claims Analyst is responsible for 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 rebate contract terms.

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.

• 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.

• Provide backup for Medicaid team members in any necessary functions and work with team to establish best practices within Medicaid work environment.

• 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

• 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.

Hard Skills

• 3+ years experience processing Medicaid Claims

• Experience manipulating large datasets and negotiating/conflict resolution

• Proficiency in Model-N or Revitas/Flex Medicaid or Flex/Validate system

• Microsoft Excel (Pivot Tables, V-Lookups, formulas)

Job Type

This is a Contract position with a duration of 6 Month(s).

Work Environment

The rebates team is made up of the Director of Medicaid, a manager, and several team members.

About Aston Carter:

Aston Carter provides world-class corporate talent solutions to thousands of clients across the globe. Specialized in accounting, finance, human resources, talent acquisition, procurement, supply chain and select administrative professions, we extend the capabilities of industry-leading companies. We draw on our deep recruiting expertise and expansive network to meet the evolving needs of our clients and talent community with agility and excellence. With offices across the U.S., Canada, Asia Pacific and Europe, Aston Carter serves many of the Fortune 500. We are proud to be a ClearlyRated Best of Staffing® double diamond winner for both client and talent service.

Diversity, Equity & Inclusion

At Aston Carter, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

• Hiring diverse talent

• Maintaining an inclusive environment through persistent self-reflection

• Building a culture of care, engagement, and recognition with clear outcomes

• Ensuring growth opportunities for our people

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email astoncarteraccommodation@astoncarter.com (%20astoncarteraccommodation@astoncarter.com) for other accommodation options.