Data Processing Review Subject Matter Expert

Position Description

Serco is seeking a motivated Data Processing subject Matter Expert to join our talented and fast-paced Public Sector Solutions team in supporting CMS' implementation of the Payment Error Rate Measurement (PERM) Program to produce national Medicaid and Children's Health Insurance Program (CHIP) improper payment estimates as required by the Payment Integrity Information Act of 2019 (PIIA). As part of this effort, Serco would execute the PERM review contract which includes collection of state eligibility policies and medical records; eligibility reviews, medical reviews, and Data Processing Reviews, of selected state Medicaid and CHIP fee-for-services (FFS) and managed care claims; and supporting state and national reporting of payment error rate and development of corrective actions based on findings.

 

The Data ProcessingSubject Matter Expert position would be responsible to provide expertise and overall review support to teams in overseeing, reviewing, researching, and investigating claims processing systems and processes. The position advises on the business and operational processes to ensure full optimal Data Processing Review function for timely and quality deliver of the PERM program. The candidate in this position ideally brings combination of supervisory experience and Subject Matter Expertise in claims Data Processing Review for the Medicaid and Children's Health Insurance Program.

 

Hybrid or full-time remote work. This position is contingent on contract award.

 

In this role, you will:

• Be in direct communication with the Assistant Program Director, Data Processing Review Manager, Data Processing Reviewers to provide technical direction and guidance to the Data Processing team and the CMS PERM staff, as necessary.
• Provide expertise or general claims support to teams in reviewing, researching, and investigating claims processing systems and processes to ensure quality claims data review to meet requirements of the PERM program.
• Provide guidance in determining state compliance with federal and state regulations and policy.
• Identify updates on Data Processing protocols and improvements to streamline and automate business and systems processes to increase efficiency and reduce information submission burden.

Competencies

• Knowledge and expertise in managed care claims, third-party liability, Medicaid waiver programs, and/or provider enrollment.
• Knowledge and expertise in working with states' claims processing systems (including MMIS), payment policy, payment systems, coding, billing, and compliance rules in Medicaid and CHIP.
• Extensive knowledge and expertise in determining compliance with state and federal laws, policies, rules, and regulations.
• Experience with process improvements of claims data review protocols.
• Supervisory/managerial experience in the health insurance industry, a utilization review firm, or another health care claims processing organization.
• An analytical mindset with problem-solving abilities.
• Strong leadership and organizational skills.
• Excellent communication skills, both strong orally and written skills.
• Exceptional interpersonal skills with ability to establish and maintain effective working relationships.
• Enjoy working in fast-paced and collaborative team environment.

Qualifications

The Data ProcessingSubject Matter Expert will possess a combination of experience meeting the following criteria:

• A minimum of three (3) years of experience in a supervisory or managerial role in medical claims or clinical data management;
• A minimum of five (5) years working in Medicaid and/or CHIP, providing technical assistance in all aspects of Medicaid and CHIP, including program integrity;
• Experience working with managed care claims, third-party liability, Medicaid waiver programs, and provider enrollment;
• Extensive experience working with states' claims processing systems (including MMIS), payment policy, payment systems, coding, billing, and compliance rules in Medicaid and CHIP;
• Extensive experience in determining compliance with state and federal laws, policies, rules, and regulations; and
• A Bachelor's degree from an accredited university and in a field of study that can be reasonably interpreted to perform tasks related to this position.

If you are interested in supporting our mission and working with a passionate team - then submit your application now for immediate consideration.  It only takes a few minutes and could change your career!

Company Overview

Serco Inc. (Serco) is the Americas division of Serco Group, plc. In North America, Serco's 9,000+ employees strive to make an impact every day across 100+ sites in the areas of Defense, Citizen Services, and Transportation. We help our clients deliver vital services more efficiently while increasing the satisfaction of their end customers. Serco serves every branch of the U.S. military, numerous U.S. Federal civilian agencies, the Intelligence Community, the Canadian government, state, provincial and local governments, and commercial clients. While your place may look a little different depending on your role, we know you will find yours here. Wherever you work and whatever you do, we invite you to discover your place in our world. Serco is a place you can count on and where you can make an impact because every contribution matters.

To review Serco benefits please visit: https://www.serco.com/na/careers/benefits-of-choosing-serco. If you require an accommodation with the application process please email: careers@serco-na.com or call the HR Service Desk at 800-628-6458, option 1. Please note, due to EEOC/OFCCP compliance, Serco is unable to accept resumes by email.

Candidates may be asked to present proof of identify during the selection process. If requested, this will require presentation of a government-issued I.D. (with photo) with name and address that match the information entered on the application. Serco will not take possession of or retain/store the information provided as proof of identity. For more information on how Serco uses your information, please see our Applicant Privacy Policy and Notice.

Serco does not accept unsolicited resumes through or from search firms or staffing agencies without being a contracted approved vendor. All unsolicited resumes will be considered the property of Serco and will not be obligated to pay a placement or contract fee. If you are interested in becoming an approved vendor at Serco, please email Agencies@serco-na.com.

Serco is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.

Employment Type: FULL_TIME