• Senior Data Processing Reviewer III

    Job ID 2018-2764
    Job Locations
    US-Remote
    Category
    Analyst (Business, Systems, Data)
    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
    • Error Rate Measurement
    • 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 Senior Data Processing Reviewer III (Claims Analyst III), you will be the manager 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.

     

     

    HIGHLIGHTS 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.  
    • Manage small teams of experienced staff members to ensure we continually meet and exceed expectations of CMS metrics/timeliness requirements.
    • Communication with state Medicaid staff regarding goals, processes, and timelines for PERM reviews.
    • Coordination with AdvanceMed IT staff to provide reviewer access to MMIS systems.
    • Serves as a resource for other Data Processing reviewers involving claims processing, authorization, and payment.
    • Performs 3rd level review when 1st and 2nd level Data Processing reviews are in opposition.
    • Assist in maintaining workflow balance on-site 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.
    • 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.
    • 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. 

    Qualifications

    REQUIREMENTS:

    • Bachelor’s degree or equivalent work experience, and at least four (4) years experience in medical terminology and insurance claims payment systems.
    • At least four (4) years of Medicaid/CHIP experience
    • 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
    • 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.
    • 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. 

     

    PREFERRED EDUCATION AND EXPERIENCE:

    • Three (3) to five (5) years of management experience. 
    • Ability to quickly adapt and thrive in a changing work environment.
    • Bilingual (Spanish) - Fluency in speaking, reading and understanding the Spanish language. 

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