• Data Processing Subject Matter Expert

    Job ID 2018-2436
    Job Locations
    US-VA-Henrico | US-OH-Grove City | US-MD-Baltimore
    Category
    Program / Project Management
    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

    NCI: As the Data Processing Subject Matter Expert  (Project Manager III), you will be in direct communication with the Data Processing Manager and Data Processing Reviewers and will provide technical direction and guidance to the data processing team and to the CMS PERM staff, as necessary. The Data Processing Subject Matter Expert will provide expertise and general claims support to teams in reviewing, researching, and investigating claims processing systems and processes. The Data Processing Subject Matter Expert will also provide guidance in determining state compliance with federal and state regulations and policy.  In assuming this position, you will be a critical contributor to meeting NCI AdvanceMed's mission: To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse. 

    Qualifications

    Requirements: 

    • 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.
    • A minimum of three (3) years of experience in a supervisory or managerial role in medical claims or clinical data management;
    • A minimum of six (6) years working in Medicaid and/or CHIP, providing technical assistance in all aspects of Medicaid and CHIP, including program integrity;
    • Knowledge, expertise, and working experience, to include but not limited to: managed care claims, third-party liability, Medicaid waiver programs, and provider enrollment;
    • Knowledge, expertise, and experience, to include but not limited to: working with states’ claims processing systems (including MMIS), payment policy, payment systems, coding, billing, and compliance rules in Medicaid and CHIP;
    • Extensive knowledge and expertise in determining compliance with state and federal laws, policies, rules, and regulations

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