NCI is a leading provider of enterprise solutions and services to U.S. defense, intelligence, health and civilian government agencies. NCI's AI solution, Shai(tm), scales humans with artificial intelligence by empowering the workforce to meet their mission by using best in class AI solutions coupled with our exceptional service offerings. Working with strategic partners, NCI is committed to bringing commercial innovation to missions of national importance. NCI is a mid-tier systems integrator headquartered in Reston, VA, and operates at locations across the globe.
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NCI: The PERM Policy Specialist will be responsible for the review of all Medicaid and Children’s Health Insurance Program (CHIP)-related policies, including state and federal policies, rules, regulations, and sub-regulatory guidance; advising PERM data processing and review staff on interpretation of policy; and discussing the effect of policy on review findings. The Policy Specialist will ensure all policy related requirements and deliverables listed in the PERM SOW are completed thoroughly and timely, including compilation and completion of each state’s Master Policy List, upload and processing of all state policies, and compilation and completion of the Federal Regulation tracker. The Policy Specialist will also work with data processing and medical review SMEs to discuss policy interpretation, as well as applications development staff to ensure all policies are uploaded properly as required in the SOW. 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:
- Identify location of all state Medicaid/CHIP policies and regulations relevant to the submission and payment of Medicaid/CHIP claims and provider enrollment.
- Review policies and track findings relevant to data processing, medical reviews, or PERM SOW deliverables in Excel spreadsheets for internal use or CMS submission.
- Administer the Medical Records Request (MRR)/Medical Review (MR) Policy Questionnaire to states at the beginning of each cycle, collaborate with states to obtain all needed information, and incorporate policy information from the Questionnaires into the Master Policy Lists.
- Discuss policies with data processing and medical review SMEs and advise on interpretation and effect on review findings.
- Prepare spreadsheets with policy information on specific review topics.
- Work with each state to compile a Master Policy List each cycle and ensure timely uploading to the PERM system.
- Compile a quarterly tracker of all Medicaid and CHIP-related federal regulations and other trackers as specified by CMS.
- Meet all deliverables in a timely manner, including ad hoc deliverables not included in the PERM SOW.
- Communicate with PERM stakeholders, including CMS, states, and other contractors to discuss policy.
- Be able to handle numerous projects at one time and respond timely to urgent requests from reviewers.
- Remain current with changes in regulatory standards and track those that effect findings.
- Bachelor's or Master's Degree from an accredited institution and in a field of study that can be reasonably interpreted to perform tasks related to the Policy Specialist position.
- Considerable program knowledge of the principles and practices of Medicaid and CHIP
- Familiarity with Medicaid/Medicare provider enrollment processes and polic
- Effective time management and prioritization skills; able to work independently
- Ability to plan and manage multiple assignments and projects and adjust to changing prioritie
- Proficiency with MS Office and Excel software
- Strong communication skills
- Ability to multi-task in a fast-paced environment
- A minimum of 7 years of post-graduate work experience in Medicaid and/or CHIP
- Familiarity with CPT, ICD-10, and HCPCS codes
- Experience with Medicare/Medicaid/CHIP policy review and interpretation
This position requires the ability to perform the below essential functions:
It is the policy of NCI to provide equal opportunity in recruiting, hiring, training, and promoting individuals in all job categories without regard to race, color, religion, national origin, gender, age, disability, genetic information, veteran status, sexual orientation, gender identity, or any other protected class or category as may be defined by federal, state, or local laws or regulations. In addition, we affirm that all compensation, benefits, company-sponsored training, educational assistance, social, and recreational programs are administered without regard to race, color, religion, national origin, gender, age, disability, genetic information, veteran status, sexual orientation, or gender identity. It is our firm intent to support equal employment opportunity and affirmative action in keeping with applicable federal, state, and local laws and regulations. NCI is a VEVRAA Federal Contractor.