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Medicaid Process Dispute Analyst
The Medicaid Process & Dispute Lead is responsible for providing functional expertise, process leadership and timely, accurate & compliant administration and adjudication of Medicaid claims for Bayer's US healthcare businesses. Furthermore, this role is also responsible for maintaining the dispute management process and fostering relationships with the third-party vendors who help facilitate them. The candidate will manage high degree of ambiguity and complexity, while also possessing strong customer/stakeholder relationship management, as well as broad Business Acumen, communication skills to influence and lead change.
YOUR TASKS AND RESPONSIBILITIES
The primary responsibilities of this role, Medicaid Process Dispute Analyst, are to:
Analyze and process high volume of State Medicaid claims withintight timeframes to avoid late penalties while identifying and properlydisputing invoicing errors.;
Provide subject expertise and operational support for federal,state and supplemental claim programs;
Responsible for maintaining accurate records of outstandingdisputes as well as negotiating with the states to bring disputes toresolution;
Ability to identify and operationalize process improvementopportunities within the team to enhance efficiency and effectiveness indelivering best in class Medicaid services;
Ensure that the team operations in compliance with federal andstate regulations governing the Medicaid program. This includes stayingup to date on policy changes and implementing necessary adjustments;
Responsible for leading team in ad hoc activities each quarterincluding ADM restatement process, pulling T-bill rates, updating andmaintaining vendor accounts and various other cleanup activities;
Responsible for identifying and assisting with system updatesregarding supplemental contracts, and assisting with review,documentation and formalization of Government Pricing Policies andStandard Operating Procedures;
Lead the team by creating new quarterly analytical reports andmodels, utilizing the Model N system, to accurately forecast Medicaidinvoicing timelines and program invoice tracking to ensure timelyadjudication of all state and federal invoices;
Support actively Pharma Finance functions by running analytics toaccurately forecast future quarter invoicing as well as providesupporting reports to anomalies or changes in claim submissions;
Provide insight with in-depth analytics and reporting to internaland external parties, including trend analysis of units, sales and pricepoints, dispute analysis, and KPI analysis;
Responsible for collecting evidence and managing all inquiriesfrom auditors in a timely manner to support compliance for internal andexternal audits;
Responsible for leading various team projects, such as RPA BotIntegration, Model N system implementation and upgrade projects, etc.;
Cultivate and maintain relationship with external stakeholdersincluding individual State Medicaid personal and third-party vendorsassisting in data scrubbing;
Foster and maintain relationships with internal stakeholders,including Government Pricing, Finance, IT, Legal, Gross to Net, andother key stakeholders;
Act autonomously within the collaborative framework provided bythe Medicaid Manager and partners to further develop this blueprint.
Partner with the Gross to Net team to ensure a design forseamlessly managing disputes that meets federal and state mandates,maintains workload for the team and continues to increase savings forBayer.
WHO YOU ARE
Bayer seeks an incumbent who possesses the following:
Required Qualifications:
Bachelor's degree;
Experience preferred in customer service experience,preferably within Top Tier US Healthcare Company working with Medicaidclaims;
Outstanding attention to detail and adaptability to deliver worldclass results across a complex network of partners, providers andstakeholders;
Strong mathematical and analytical skills are required to addresscomplex issues related to Medicaid program administration;
Strong knowledge of SAP & Microsoft Suite
Strong organizational and project management skills with theability to prioritize tasks and manage multiple responsibilitiessimultaneously
Prior experience in Vistex, Model N or other contractadministration tool supporting Medicaid claims processing in US industryis strongly preferred.
Must be able to work in a collaborative team environment andpresent complex information clearly and with confidence
Excellent communications, stakeholder management and problem-solving skills;
Fluent English skills both in spoken and written form;
Digital savvy and continuous process improvement mindset as wellas financial literacy and high business acumen desired;
Ability to handle multiple information and databases, preferablyknowledge of BI reporting tools such as Tableau or Power BI;
Courage and driving results in transforming environment;
Customer oriented and manages complexity;
Be able to manage ambiguity and market complexity
Preferred Experience:
5 years' experience preferred in customer service experience,preferably within Top Tier US Healthcare Company working with Medicaidclaims
This posting will be available for application until at least 11/30/2024
#LI-US
YOUR APPLICATION
Bayer offers a wide variety of competitive compensation and benefits programs. If you meet the requirements of this unique opportunity, and want to impact our mission Science for a better life, we encourage you to apply now. Be part of something bigger. Be you. Be Bayer.
To all recruitment agencies: Bayer does not accept unsolicited third party resumes.
Bayer is an Equal Opportunity Employer/Disabled/Veterans
Bayer is committed to providing access and reasonable accommodations in its application process for individuals with disabilities and encourages applicants with disabilities to request any needed accommodation(s) using the contact information below.
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification form upon hire.
Bayer is an E-Verify Employer.
Location:
United States : New Jersey : Whippany
Division:
Pharmaceuticals
Reference Code:
832554
Contact Us
Email:
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