Medicaid Reviewer I

Catapult Consultants, LLC - United States4.1

Full-time
Catapult Consultants LLC is seeking a Medicaid Reviewer I to work on a federal government project for the Centers for Medicare & Medicaid Services (CMS). This project, the Payment Error Rate Measurement Review Contractor (PERM RC) performs data processing reviews. These reviews include the following activities: researches, collects, and requests state Medicaid and Children's Health Insurance Program (CHIP) medical policies from the states, request and receive medical records from providers, perform the medical reviews, collect claims payment policies, fee schedules, and processing system manuals for data processing review, visit state offices and/or provide web-based calls for orientation to RC processes. The RC will visit state offices and/or remotely perform data processing reviews and incorporate the ERC findings in the State Medicaid Error Rate Findings (SMERF) system.

This individual will conduct data processing reviews on each sampled FFS and managed care payment to validate that the claim was processed correctly based on information found in the state's claim processing system and other supporting documentation maintained by the state. This work may be applicable for Medicaid and CHIP claims processed in all 50 states and the District of Columbia.
**Interested applicants should apply online with a resume and cover letter by 2/20/19. The cover letter should describe how you meet or exceed the Minimum Qualifications listed below.

1 position will be filled
Work through 8/23/2019 with possibility of extension
Full-Time with full benefits (3 weeks paid vacation &10 paid holidays per year; medical, dental, vision & life insurance; and 401k with a 4% company match)
Perform the work primarily while on travel to Medicaid state locations (50-70%) and while working at home (30-50%). Travel will be scheduled for 2 weeks at a time to fly out on Sunday and work through at least Noon on the second Friday. Travel will be to IL, VA, WI, NM, MN, WY, KS & PA.
Hired as an employee of Catapult Consultants, LLC and will work daily with employees of NCI Inc./AdvanceMed Corporation

Minimum Qualifications:Education:
Bachelor’s degree or equivalent work experience

Experience:
At least 2 years' experience with Medicaid/CHIP data (specify which states on resume and cover letter)

Skills, Knowledge & Abilities:
  • Extensive knowledge of medical terminology and coding principles
  • Ability to read insurance claims, both paper and electronic, and a basic knowledge of the insurance claims systems
  • Ability to read and understand complex Medicaid policies
  • Knowledge of, and the ability to correctly identify, insurance coverage guidelines
  • Familiarity with CPT codes, ICD-10-CM codes, and HCPCS codes
  • Strong critical thinking and decision making capability
  • Knowledge of and ability to use Microsoft Word, Excel and Internet applications
  • Ability to quickly adapt and thrive in a changing work environment.
  • Must have no adverse actions pending or taken by any State or Federal licensing board or program
  • Must live within reasonable commuting distance of a major airport
  • Must have and maintain a valid driver's license for state of residence
  • Fingerprint background check may be required
Responsibilities:
PERM Medicaid Review Analyst 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. This position will be responsible for auditing Medicaid FFS, Medicaid CHIP and managed care claims. The work will be performed remote and at the Medicaid state locations. Expecting 50-70% travel. Onsite work will be scheduled for two weeks at a time. Will need to fly out on Sunday and be prepared to work through noon on Friday.

Extensive travel (air/car) – 60-75% 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.

Complete Data Processing reviews in accordance with internal and CMS metrics/timeliness requirements. Communicate and collaborate process improvements identified to the Data Processing management team to ensure we continually meet and exceed expectations.

Review and analyze multiple claim processing, eligibility enrollment, and provider enrollment systems. Make an informed decision to determine if the information in all systems resulted in an accurate payment determination.

Independently research complex situations, arrive at an accurate conclusion. Work with Senior reviewers or Leads when assistance is needed in completing reviews.

Consult with Senior Reviewers and Leads about the implication of how state and federal policies and regulations are applied in differing claims scenarios.

Collaborate with Senior Reviewers and Leads about how state and federal policies and regulations are applied to specific claim scenarios in front of stakeholder staff. Collaborate directly with stakeholder staff and the customer about complex review scenarios and how state and federal regulations are applied.

Prepare responses to ad hoc questions from Data Processing Management related to complete or in progress reviews.

Coordination with AdvanceMed IT staff and stakeholder IT staff to complete reviewer access forms for the state MMIS 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.

Abilities Required:
  • While performing the duties of this job the employee is regularly required to sit and use hands to finger, handle, or feel while typing at a computer keyboard.
  • The employee is occasionally required to stand, walk, reach, or lift objects up to 10 pounds.
  • The employee is frequently required to talk or hear. The vision requirements include: close vision.
EEO Statement
Catapult Consultants is an Equal Opportunity Employer. We believe that every employee has the right to work in a dignified work environment free from all forms of discrimination and harassment. It’s our policy to recruit, employ, retain, compensate, train, promote, discipline, terminate and otherwise treat all employees and job applicants based solely on qualifications, performance, and competence. This policy reflects our belief that providing equal opportunities for all employees is a both our legal and moral responsibility, and good management practice.

All employees and applicants are treated without regard to age, sex, color, religion, race, national origin, citizenship, veteran status, current or future military status, sexual orientation, gender identification, marital or familial status, disability or any other status protected by law.
Disclaimer
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.