Health Policy Medical Claims Assistant Program Director - Serco North America

Serco is seeking a motivated Assistant Program Director for Medical Claims Review 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; medical reviews, data processing reviews, and eligibility reviews of selected state Medicaid and CHIP fee-for-services (FFS) and managed care claims; and supporting state and national reporting and development of corrective actions based on findings. The Assistant Program Director for Medical Claims Review would be responsible for management the medical and claims review, ensuring optimal delivery of program processes and operations, as well contract deliverable and budget management.

The candidate in this position ideally brings unique combination of extensive program management experience and subject matter expertise in medical claims verification, including medical records review and claims processing review for the Medicaid and Children’s Health Insurance Program. The position also is responsible for the business and system processes to coordinate and optimize multiple aspects medical and claims review operations.

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

In this role, you will:

• Manage all aspects of the PERM medical and claims reviews, including review policies, business process; operations and contract deliverables, for estimating Medicaid and CHIP eligibility error rate and improper payments.
• Oversee medical and claims review staffing, training, quality assurance, production, IT systems and access, innovation and improvements, and support the financial and budget management aspect of the PERM contract.
• Serve as the primary point of contact with the CMS SMEs and states on medical and claims review policies, processes, operations, error rate analysis, findings and appeals.
• Serve as the primary point of contact for PERM statistical contractor, subcontractors, and states on medical records and claims processing reviews, and reporting of findings.

Competencies 

• Thorough understanding of project/program management techniques and methods with proven management of large government program or contracts.
• Demonstrated knowledge of data analysis, performance evaluation techniques, key metrics and reporting.
• 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.
• Demonstrated good judgment, business acumen with a strategic ability, and the ability to think constructively.
• Ability to deal with complex and changing policy and political environment.
• Enjoy working in fast-paced and collaborative team environment.

Required Qualifications

• Holds a bachelor's degree or master's degree from an accredited university and in a field of study that can be reasonably interpreted to perform tasks related to this position
• A minimum of three (3) years project management experience overseeing mid to large projects, budget and staff;
• Supervisory/managerial experience related to the performance of medical documentation reviews;
• Working experience with electronic medical records or electronic transmission of medical records;
• Preferably three years working in Medicaid and/or CHIP at a state or national level with experience working with states’ claims processing systems and/or the medical review process; a
• Preferably meeting two of the following criteria:
• Is a registered health information administrator,
• Is a registered health information technologist,
• Is a certified professional coder.

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!

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.