Medicaid Claims Analyst - Cynet Systems - Parsippany, NJ, US | Dice.com

Cynet Systems

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Medicaid Claims Analyst

Parsippany, NJ, US • Posted 6 hours ago • Updated 6 hours ago

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Summary

We are looking for Medicaid Claims Analyst for our client in Parsippany, NJ

Job Title: Medicaid Claims Analyst

Job Location: Parsippany, NJ

Job Type: Contract

Job Description:

Pay Range: $55hr - $60hr

The Medicaid Claims Analyst is responsible for reviewing, validating, and processing Medicaid Summary and Claim Level Invoices to ensure compliance, accuracy, and completeness.
This role involves detailed data analysis, dispute resolution, and collaboration with internal and external stakeholders to ensure timely and accurate Medicaid rebate processing.

Responsibilities:

Work with assigned states to obtain Medicaid Summary Invoices, Summary Data Files, and Claim Level Invoices each quarter and review for completeness.
Upload data into Medicaid systems and authorize transactions. Document and research any errors.
Conduct initial quality checks on claim submissions to confirm rebate eligibility and data consistency.
Perform claim-level detail validation and review suspect claim records to determine payment disputes.
Resolve disputes and propose recommended amounts for payment on historical utilization claims.
Apply appropriate CMS codes and ensure accurate communication of findings to state agencies.
Complete Medicaid analysis and documentation for assigned states and programs.
Communicate findings, program changes, and key insights to management.
Provide backup support for Medicaid team members and contribute to developing best practices.
Support Model N / Medicaid systems, including data uploads, validation, and research.
Ensure high levels of data integrity and accuracy in all processing and reporting activities.

Requirement / Must Have:

Bachelor s degree or equivalent combination of education and experience.
Prior Medicaid claim processing experience within a pharmaceutical, medical device company, state agency, or as a Medicaid consultant.
Knowledge of Medicaid systems such as Model N, Revitas/Flex Medicaid, or comparable systems.
Advanced proficiency in Microsoft Excel.
Familiarity with CMS Medicaid rules and state-specific issues.
Strong analytical and data interpretation skills with attention to detail and accuracy.

Experience:

Minimum 2+ years of pharmaceutical or product-focused healthcare experience.
Experience in Medicaid claim processing, data manipulation, and conflict resolution.
Experience with system implementation and report writing.

Skills:

Strong ability to organize and manage large data sets in multiple formats.
Excellent analytical and problem-solving abilities.
Solid understanding of accounting principles and internal controls.
Advanced data management and Excel skills.
Effective communication and interpersonal skills with the ability to build trust and credibility.
Strong organizational and time-management skills with the ability to handle multiple priorities.

Qualification and Education:

Bachelor s degree in Business, Finance, Healthcare, or related field preferred.
Equivalent combination of relevant training and work experience considered.

Travel Requirements:

Minimal

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 10516350
Position Id: NJ_MCAL_1105
Posted 6 hours ago

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Medicaid Claims Analyst

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