• Data Processing Reviewer II

    Job ID 2018-2763
    Job Locations
    Analyst (Business, Systems, Data)
    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
    • Error Rate Measurement
    • Engineering and logistics


    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.


    NCI: As the Data Processing Reviewer II (Claims Analyst II), you will be responsible for initiating, supporting, monitoring and evaluating data processing review activities related to the PERM task order, including compliance with contract deliverables, internal and external performance requirements, and continual improvement. This position is responsible for providing support to the Data Processing Review Management staff and Operations area. In assuming this position, you will be a critical contributor to meeting NCI's mission: To deliver innovative, cost-effective solutions and services that enable our customers to rapidly adapt to dynamic environments.



    Hightlights of Responsibilities: 

    • Extensive travel (air/car) – 25 to 35 weeks per year - with your team to scheduled states for Data Processing reviews. Travel will generally be Sunday through Thursday and/or Friday based on workload.  
    • Assist in maintaining workflow balance to ensure prepayment claims are moved timely to safe statuses, exports are updated and sent timely and accurately, and claims are not aging in the Claims Processing Systems.
    • Assist Senior Data Processing Reviewer as assigned to contribute to goals and objectives.
    • Remain mindful of CMS metrics/timeliness requirements and identifies process improvements to ensure we continually meet and exceed expectations.
    • Utilize working knowledge of medical terminology and experience in the analysis and processing of Medicaid and/or CHIP and states’ claims processing systems.
    • Monitor Claim Payment Systems and notify management of potential problems/errors and of potential areas for improvement.
    • Enter final decisions into AdvanceMed system.
    • Prepare reports as needed for both internal and external customers.
    • Complete assignments in a manner that meets or exceeds the quality assurance goal for accuracy.
    • Maintain chain of custody on all documents and follows all confidentiality and security guidelines.



    • Bachelor’s degree or equivalent work experience, and two (2) to seven (7) years of experience in medical terminology and Medicaid claims payment systems.
    • Minimum two (2) years' experience with Medicaid/CHIP data.
    • Must live within reasonable communting distance of a major airport.
    • Extensive knowledge of medical terminology and coding principles.
    • Ability to read insurance claims, both paper and electronic, and a basic knowledge of insurance claims systems
    • Knowledge of, and the ability to correctly identify, insurance coverage guidelines
    • Familiarity with CPT codes, ICD-10-CM codes, and HCPCS codes
    • Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program
    • Must have and maintain a valid driver's license for the associate’s state of residence.



    • Ability to quickly adapt and thrive in a changing work environment.
    • Knowledge of and ability to use Microsoft Word, Excel and Internet applications.
    • Familiarity with computer systems in general, including accessing FTP websites and DOS systems.
    • Bilingual (Spanish) - Fluency in speaking, reading and understanding the Spanish language. 


    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed

    Connect With Us!

    Not ready to apply? Connect with us for general consideration.