• Medicaid Subject Matter Expert

    Job ID 2018-2382
    Job Locations
    US-OH-Grove City
    Category
    Other
    Type
    Regular Full-Time
  • Overview

    NCI is a leading provider of enterprise solutions and services to U.S. defense, intelligence, health and civilian government agencies. Coupled with a refined focus on strategic partnerships, we are successfully bridging the gap between commercial best practices and mission-critical government processes. Core competencies include:

    • Artificial intelligence
    • Agile digital transformation
    • Advanced analytics
    • Hyperconverged infrastructure solutions
    • Cyber security and information assurance
    • Fraud, waste and abuse
    • Engineering and logistics

    MF18

    NCI has been designated a 2018 Military Friendly Employer by MilitaryFriendly.com 

     

    Headquartered in Reston, Virginia, NCI has approximately 2,000 employees operating at more than 100 locations worldwide.

     

    Responsibilities

    ESSENTIAL FUNCTIONS BY LEVEL:

     

    Provides subject matter expertise and technical assistance on matters related to Medicaid policies and regulations. Supports the Data Analysis, Medical Review, and Program Integrity teams by consultation with staff and by participating in investigative and/or data analysis efforts. Attends meetings to provide expertise regarding relevant Medicaid policies and regulations.

    • Serves as an information resource for Data Analysis, Program Integrity, and Medical Review teams by researching Medicaid coverage criteria, regulations, and policies.
    • Remains informed of current Medicaid fraud and abuse issues/schemes through researching reports such as CMS MIG Reviews, OIG State Reports, National Association of Medicaid Directors (NAMD) Briefs and other resources included in the Medicaid SME Research list.
    • Assists in development of proactive data analysis studies and participates in proactive consultation team meetings.
    • Researches and adds relevant state Medicaid policy and regulations to state collaboration vetting forms based on the alleged scheme associated with the investigative lead.
    • Proactively seeks out and develops Medicare and Medicaid fraud or abuse leads from various sources including CMS, state Medicaid agencies, law enforcement, fraud alerts, or other sources.
    • Develops and conducts Medicaid training for internal and external stakeholders.
    • Compiles state Medicaid information for Medi-Medi reporting such as Data Analysis Reports, Monthly Status Reports, Annual State Reports and others as requested.
    • Identifies and develops state program vulnerabilities.  
    • Supports the Medicaid appeal process.
    • Monitors state Medicaid provider’s suspension and exclusion databases.
    • Develops and maintains state Medicaid profiles and updates expenditures, statistical information and changes in program structure or services as needed.
    • Attends Medicaid Program Integrity Coordination (MPIC) meetings with external customers.
    • Ensures confidentiality of all PHI and sensitive information.
    • Travels as required for meetings or training.
    • Performs other duties as assigned.

    Qualifications

    MINIMUM REQUIREMENTS:

    • BA or BS degree preferred with preference given to those candidates with degrees in health related fields and those with an active license as a Registered Nurse (RN).
    • High proficiency level with Microsoft Excel and Word.Working knowledge of Microsoft Access and PowerPoint.Excellent verbal and written communication skills.
    • Excellent research skills including internet research.
    • Ability to work independently with minimal supervision.
    • Ability to perform multiple priority tasks.
    • Associate must have and maintain a valid driver’s license issued by his/her state of residence.

     

    EXPERIENCE REQUIRED BY LEVEL:

    • Required seven years of Medicaid experience working in a State Medicaid program with preference for having worked in a program integrity area.
    • III: 4 – 9 Years
    • IV: 7 – 12 Years
    • V: 10 – 15 Years

     

    PREFERRED EDUCATION AND EXPERIENCE:

    • Master’s Degree in health related field.

     

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