Job Information
Serco Medicaid/CHIP Data Processing Review Manager in Washington, District Of Columbia
Position Description
Serco is seekinga motivated Data Processing 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; eligibility reviews, medical reviews, and data processing reviews, of selected state Medicaid and CHIP fee-for-services (FFS) and managed care claims; and supporting state and national reporting and development of corrective actions based on findings.
The Data Processing Review Manager position would be responsible to provide expertise and general claims support to teams in overseeing, reviewing, researching, and investigating claims processing systems and processes.The position oversees the business and operational processes to ensure the full optimal data processing review function for timely and quality delivery of PERM program.The candidate in this position ideally brings combination of strong supervisory experience and subject matter expertise in claims data processing review for the Medicaid and Children’s Health Insurance Program.
Hybrid or full-time remote work. This position is contingent on contract award.
In this role, you will:
Be in direct communication with the Program Director, Assistant Program Director for Medical Claims Review, Data Processing Reviewers, and CMS PERM staff, as necessary, to provide and provide expert clinical guidance and technical assistance.
Provide expertise or general claims support to teams in reviewing, researching, and investigating claims processing systems and processes to ensure quality claims data review to meet requirements of the PERM program.
Identify updates on data processing protocols and improvements to streamline and automate business and systems processes to increase efficiency and reduce information submission burden.
Competencies
Knowledge and working experience working the managed care claims and third- party liability;
Knowledge of payment systems and coding, billing and compliance rules; and
Knowledge of the Medicaid and/or CHIP program, particularly the coverage, conditions of payment, and state-specific policy requirements for health care coverage and payment;
Experience with process improvements of claims data review protocols
Supervisory/managerial experience in the health insurance industry, a utilization review firm, or another health care claims processing organization
An analytical mindset with problem-solving abilities.
Strong leadership and organizational skills.
Excellent communication skills, both strong orally and written skills,
Exceptional interpersonal skills with ability toestablish and maintain effective working relationships.
Enjoy working in fast-paced and collaborative team environment.
Qualifications
The Data Processing Review Manager will possess a combination of experience meetingthe following criteria:
A minimum of three (3) years of supervisory or managerial experience in medical claims or clinical data management;
Preferably three (3) years working in Medicaid and/or CHIP at a state or national level with working with states’ claims processing systems, including MMIS;
Preferably three (3) years of supervisory/managerial experience in the health insurance industry, a utilization review firm, or another health care claims processing organization
Knowledge and working experience working the managed care claims and third- party liability;
Knowledge of payment systems and coding, billing and compliance rules; and
A Bachelor’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 63795
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