Medicaid Reconciliation Analyst

Overview We are seeking an experienced Medicaid Analyst 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. Accountable for submitting payments within deadlines and in compliance with CMS guidelines and rebate contract terms. This position also provides assistance in resolving dispute resolution, weekly pay run activities, SOX audits, system upgrade/implementation and ad hoc analysis. Location: North/Central New Jersey area, 2 to 3 days onsite per week Duration: 6 months Pay Rate Range: $55/hr-$70/hr What you will work on 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 determine 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. Work independently to make recommendations on state disputes, apply proper amounts to be paid and ensure CMS codes are applied correctly; notify states of results/findings. Complete Medicaid analyses and documentation on assigned states/programs. Communicate key findings and changes to state programs to the manager. Provide backup for Medicaid team members and work with the team to establish best practices within the organization’s 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. Perform Claim Level Detail validation. Review suspect claim records and determine 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. Work independently to make recommendations on state disputes, apply proper amounts to be paid and ensure CMS codes are applied correctly; notify states of results/findings. Complete Medicaid analyses and documentation on assigned states/programs. Communicate key findings and changes to state programs to the manager. What you will bring High School Diploma required. Bachelor’s degree preferred. Any equivalent combination of experience, training and/or direct work related experience will be considered. 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. REQUIRED Minimum of 2+ years pharmaceutical/product focused healthcare experience; Medicaid Claim processing function; manipulation of large datasets, negotiation/conflict resolution. System Implementation and report writing. Knowledge of the Model N or Revitas/Flex Medicaid and/or Flex Validata system (or other comparable system) and advanced 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. What you can expect An inspirational place for you to do your best work, be engaged in meaningful ways, and continually develop the skills and competencies that set our team apart. Compensation commensurate with your qualifications, experience, and other factors including geographic location, market and operational factors. Total rewards include: Medical, Dental, Vision, Life Insurance, Disability Insurance, 401(k) Savings Plan, Employee Stock Purchase Plan, Professional Development Program, Paid Time Off and Paid Sick Time (in geographies where legally required). EEO statement: RGP is an Equal Opportunity Employer and committed to creating an inclusive environment for all employees. We do not discriminate on the basis of race, color, religion, national origin, gender, pregnancy, sexual orientation, gender identity, age, physical or mental disability, genetic information, veteran status, or any other legally protected trait and encourage all applicants to apply. #J-18808-Ljbffr