Medicaid/CHIP Eligibility Assistant Program Director - Serco North America

Serco is seeking a motivated Assistant Program Director for Eligibility 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; supporting state and national reporting; and development of corrective actions based on review findings. The Assistant Program Director for Eligibility Review position would be responsible for management of the eligibility reviews, ensuring optimal communication, coordination, and delivery of program processes and operations.

The candidate in this position ideally brings unique combination of program management and subject matter expertise in health insurance eligibility, particularly for the Medicaid and Children’s Health Insurance Program, as well as technical understanding of program integrity or audit processes to coordinate and optimize multiple aspects of PERM eligibility review policy and 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 eligibility reviews, including eligibility review policies, business process; operations and contract deliverables, for estimating Medicaid and CHIP eligibility error rate and improper payments.
• Oversee eligibility review staffing, training, quality assurance, production, IT systems and access, innovation and improvements.
• Serve as the primary point of contact with the CMS SMEs and states on eligibility review policies, processes, operations; error rate analysis, findings and appeals.
• Serve as the primary point of contact and coordination for PERM statistical contractor and subcontractors on eligibility reviews.

Competencies

• Proven management of large government program or contracts – including program policies, processes, operations, staffing, training, quality assurance, IT systems, and financial management.
• Strong working knowledge of Medicaid and CHIP, including state eligibility systems, state eligibility process and state eligibility policies.
• Strong understanding of working on PERM eligibility.
• Extensive experience working with states on Medicaid and CHIP program.
• Demonstrated capabilities in qualitative and quantitative research and analysis, especially related to CMS programs.
• Strong leadership and organizational skills.
• Exceptional interpersonal skills with ability to establish and maintain effective working relationships.
• Ability to communicate effectively, both strong orally and written skills, with government and state stakeholders.
• Demonstrated good judgment, a well-developed sense of propriety, political acumen, 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

• A Bachelors or Master’s degree in public policy or administration, business administration or management, or related degree’
• A minimum of five (5) years project management experience working on complex government programs or contracts
• Strong understanding and experience working PERM eligibility
• A minimum of three (3) years of experience working with state Medicaid and CHIP

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.