Medicaid Reviewer I

Overview

Empower AI is AI for government. Empower AI gives federal agency leaders the tools to elevate the potential of their workforce with a direct path for meaningful transformation. Headquartered in Reston, Va., Empower AI leverages three decades of experience solving complex challenges in Health, Defense, and Civilian missions. Our proven Empower AI Platform provides a practical, sustainable path for clients to achieve transformation that is true to who they are, what they do, how they work, with the resources they have. The result is a government workforce that is exponentially more creative and productive. For more information, visit www.Empower.ai.

 

Empower AI is proud to be recognized as a 2022 Military Friendly Employer by Viqtory, the publisher of G.I. Jobs. This designation reflects the company's commitment to hiring and supporting active-duty and veteran employees.

 

Responsibilities

Empower AI: 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 Empower AI'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.

Qualifications

Requirements:

• Bachelor's degree or equivalent experience (4 years of related experience equivalent to a Bachelors)
• At least one (1) year work experience with Medicaid or CHIP data
• Must live within reasonable communting 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 Education and 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

Physical Requirements:

 

This position requires the ability to perform the below essential functions:

• Ambulate throughout an office

 

About Empower AI

It is the policy of Empower AI 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.  Empower AI is a VEVRAA Federal Contractor.

 

Employment Type: FULL_TIME