• Medicaid Reviewer I

    Job ID 2019-3288
    Job Locations
    Analyst (Business, Systems, Data)
    Regular Full-Time
  • Responsibilities

    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.



    • Bachelor’s Degree with at least one (1) year work experience with Medicaid or CHIP data
    • Must live within reasonable commuting distance of a major airport
    • 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
    • Working knowledge of medical terminology and experience in the review of Medicaid electronic claims are required as well as experience related to specific workload of the individual task order, which may be further defined in the Task Order Statement of Work.
    • 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 Experience:

    • Ability to quickly adapt and thrive in a changing work environment.
    • Ability to read insurance claims, both paper and electronic, and a basic knowledge of the insurance claims systems


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