NCI: As a Medicaid Reviewer I, you will be responsible for initiating, supporting, monitoring and evaluating medical 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. Works under general supervision of Senior Data Processing Reviewer in performance of daily tasks.
- 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 and prepare reports as needed.
- 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.