Catapult Consultants LLC is seeking a Medicaid Reviewer I to work on a federal government project, the Payment Error Rate Measurement Review Contractor (PERM RC), for the Centers for Medicare & Medicaid Services (CMS). The Medicaid Reviewer I will be responsible for the review of all Medicaid-related policies, including state and federal policies, rules, and regulations; advising PERM data processing and review staff on interpretation of policy; and discussing the effect of policy on review findings. 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.
This role is Full-Time with full benefits. The work will be performed 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.
- Initiate, support, monitor and evaluate medical review activities related to the PERM task order, including compliance with contract deliverables, internal and external performance requirements, and continual improvement.
- Provide support to the Data Processing Review Management staff and Operations area. 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.
- Audit Medicaid FFS, Medicaid CHIP and managed care claims. 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.
- 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.
- Consult with Senior Reviewers and Leads about the implication of how state and federal policies and regulations are applied in differing claims scenarios.
- Bachelor’s degree or equivalent work experience.
- At least 2 years’ experience with Medicaid/CHIP data (specify which states on resume and cover letter).
- 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.
- 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.
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.
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.
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