Job Information
Serco Eligibility Review Manager in Washington, District Of Columbia
Position Description
Serco is seekinga motivated Eligibility Review Manager to join our talented and fast-paced Public Sector Solutions team in supporting CMS’ implementation of the Payment Error Rate Measurement (PERM) Program to produce national Medicaid and Children’s Health Insurance Program (CHIP) improper payment estimates as required by the Payment Integrity Information Act of 2019 (PIIA).
As part of this effort, Serco would execute the PERM review contract which includes collection of state eligibility policies and medical records; medical reviews, data processing reviews, and eligibility reviews of selected state Medicaid and CHIP fee-for-services (FFS) and managed care claims; supporting state and national reporting; and development of corrective actions based on review findings. The Eligibility Review Manager position would be support management of the eligibility reviews, ensuring optimal communication, coordination, and delivery of program processes and operations.
The candidate in this position ideally brings unique combination of program management and subject matter expertise in eligibility review policies and processes, particularly for the Medicaid and Children’s Health Insurance Program, as well as technical understanding of program integrity or audit processes to coordinate and optimize multiple aspects of PERM eligibility review policy and operations.
Hybrid or full-time remote work. This is position is contingent on contract award.
In this role, you will:
Work in direct communication and support of the Assistant Project Director for Eligibility Review to manage key aspects of the PERM Eligibility Review.
Be responsible for oversight and quality assurance for all eligibility reviews.
Provide technical assistance to state staff as well as provide direction to all eligibility policy analysts and reviewers.
Competencies
Proven project management experience with complex program.
Strong working knowledge of Medicaid and CHIP, including state eligibility systems, state eligibility process and state eligibility policies.
Considerable program knowledge of the principles and practices of Medicaid and CHIP eligibility
Considerable knowledge of the Affordable Care Act with specific understanding of eligibility;
Ability to interpret Medicaid, CHIP, and state eligibility regulations and to analyze their
impact on current and proposed programs.
Extensive experience working with states on Medicaid and CHIP program.
Strong leadership and organizational skills.
Exceptional interpersonal skills with ability toestablish and maintain effective working relationships.
Ability to communicate effectively, both strong orally and written skills, with government and state stakeholders.
Enjoy working in fast-paced and collaborative team environment.
Qualifications
Required Qualifications
A minimum of three (3) years project management experience
A minimum of five (5) years of experience conducting Medicaid/CHIP eligibility reviews
Experience conducting quality assurance activities related to program integrity reviews
Experience conducting eligibility reviews for the PERM program
Holds a Bachelor’s Degree or Master’s Degree from an accredited university and in a field of study that can be reasonably interpreted to perform tasks related to this position.
If you are interested in supporting our mission and working with a passionate team - then submit your application now for immediate consideration. It only takes a few minutes and could change your career!
Company Overview
Serco Inc. (Serco) is the Americas division of Serco Group, plc. In North America, Serco’s 9,000+ employees strive to make an impact every day across 100+ sites in the areas of Defense, Citizen Services, and Transportation. We help our clients deliver vital services more efficiently while increasing the satisfaction of their end customers. Serco serves every branch of the U.S. military, numerous U.S. Federal civilian agencies, the Intelligence Community, the Canadian government, state, provincial and local governments, and commercial clients. While your place may look a little different depending on your role, we know you will find yours here. Wherever you work and whatever you do, we invite you to discover your place in our world. Serco is a place you can count on and where you can make an impact because every contribution matters.
To review Serco benefits please visit: https://www.serco.com/na/careers/benefits-of-choosing-serco . If you require an accommodation with the application process please email: careers@serco-na.com or call the HR Service Desk at 800-628-6458, option 1. Please note, due to EEOC/OFCCP compliance, Serco is unable to accept resumes by email.
Candidates may be asked to present proof of identify during the selection process. If requested, this will require presentation of a government-issued I.D. (with photo) with name and address that match the information entered on the application. Serco will not take possession of or retain/store the information provided as proof of identity. For more information on how Serco uses your information, please see ourApplicant Privacy Policy and Notice (https://www.serco.com/na/privacy-policy) .
Serco does not accept unsolicited resumes through or from search firms or staffing agencies without being a contracted approved vendor. All unsolicited resumes will be considered the property of Serco and will not be obligated to pay a placement or contract fee. If you are interested in becoming an approved vendor at Serco, please email Agencies@serco-na.com .
Serco is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.
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ID 63791
Recruiting Location : Location US-DC-Washington
Category Health/Medical
Position Type Full-Time
Security Clearance None
Telework Yes - May Consider Full Time Teleworking for this position