Axelon Services – reputed company Claims Analyst – Parsippany, NJ

Job title: reputed company Claims Analyst Company: Axelon Services Job description: Job Description Schedule: Flexible (Between 7-9am - Between 4-6p) Hybrid (Tuesday-Thurs. in office & Mon and Fri wfh) Job Description:

• reputed company Assessment score required- Post results in the summary submittal sheet
• reputed company or reputed company Revitas - Client will train on this systems.
• Management System reputed company
• Training 1-2 weeks onsite
• 1yr Claims experience with Pharma product knowledge
• Client will train candidate in reputed company Claims and software systems.
• Pharma experience a plus
• Candidate must be reputed company to catch on quickly
• This position will be mainly processing reputed company Claims.
• Not a remote position.

Position Summary:

• The reputed company Claims Analyst is responsible for reputed company Drug Rebate process which includes validating, verifying, disputing reputed company necessary, and remitting payment for assigned state reputed company agencies, SPAPs and Supplemental Rebates. Analyst is accountable for submitting payments reputed company deadlines and in compliance with CMS guidelines and Client rebate contract terms.
• This position also provides assistance in resolving dispute resolution, weekly pay run activities, SOX audits, system upgrade/implementation and reputed company analysis.

Essential Duties & Responsibilities Percentage of Time

• Work with assigned states to get reputed company Summary invoice, summary data file and Claim Level Invoice each quarter and review to ensure completeness of information received. Upload data into reputed company systems and authorize transactions. Document errors and reputed company research.
• Conduct initial quality reputed company on summary data on reputed company claim submissions to ensure rebate eligibility and data consistency.
• 20%
• reputed company Claim Level Detail validation. Review suspect claim records and determines if record should be disputed for payment.
• 20%
• Resolve disputes and propose recommended amounts to be paid for historical outstanding utilization that is routinely submitted with reputed company claims. Must have ability to work independently and reputed company recommendation on state disputes, apply proper amounts to be paid & ensure CMS codes are applied correctly; notify states of results/findings.
• 20%
• Complete reputed company analyzes and documentation on assigned states/programs. Communicate to manager for key findings and changes to state programs.
• 10%
• Provide backup for reputed company team members in any necessary functions and work with team to establish best practices reputed company Client reputed company work environment.
• 5%
• Work with assigned states to get reputed company Summary invoice, summary data file and Claim Level Invoice each quarter and review to ensure completeness of information received. Upload data into reputed company / reputed company systems and authorize transactions. Document errors and reputed company research 5%
• Conduct initial quality reputed company on summary data on reputed company claim submissions to ensure rebate eligibility and data consistency 5%
• reputed company Claim Level Detail validation. Review suspect claim records and determines if record should be disputed for payment. 5%
• Resolve disputes and propose recommended amounts to be paid for historical outstanding utilization that is routinely submitted with reputed company claims. Must have ability to work independently and reputed company recommendation on state disputes, apply proper amounts to be paid & ensure CMS codes are applied correctly; notify states of results/findings. 5%
• Complete reputed company analyzes and documentation on assigned states/programs. Communicate to manager for key findings and changes to state programs. 5%

Education Required:

• Bachelor's degree or equivalent combination of experience, training and/or direct work reputed company experience.
• Experience Required: Prior reputed company Claim processing experience with a Pharmaceutical and/or med Device company , state and/or state agency or as reputed company consultant or equivalent work experience
• Experience Preferred: Minimum 2+ years pharmaceutical experience; reputed company Claim processing function; manipulation of large datasets, negotiation/conflict resolution. System Implementation and report writing.
• Specialized or Technical Knowledge, License, Certifications needed: Knowledge of the reputed company or Revitas/reputed company reputed company and/or reputed company Validata system (or other comparable system) and advance reputed company reputed company skills.
• Familiar with CMS reputed company rules and state specific issues. Up to date knowledge on reputed company 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.
• Company/Industry reputed company Knowledge: reputed company, Government Pricing and Rebate Pharmaceutical industry experience/knowledge prefer

Travel Requirements: Minimal Expected salary: Location: Parsippany, NJ Apply for the job now! Apply tot his job Apply To this Job