- Be in direct communication with the Assistant Program Directors, PERM Staff, and CMS COR, to coordinate cycle activities.
- Oversee overall timeliness of the pre-cycle, cycle, and post cycle operations.
- Manage against key operating risks identified. This includes but is not limited to ensuring that:
- State PERM staff having sufficient knowledge of what they must provide to the reviewers when reviews begin;
- Contractors review staff having obtained required access to state systems prior to beginning reviews;
- Equipment and operations are in place to support secure transfer of review documentation to reviewers and to CMS;
- SMERF system is prepared with the error codes, qualifiers, sub qualifiers necessary to begin citing findings on the first day of reviews; and
- Review manuals, which represent an agreement between the RC and CMS, are finalized prior to the beginning of the reviews.
- Knowledge and expertise in determining compliance with state and federal laws, policies, rules, and regulations.
- Project management or supervisory/managerial experience in the health insurance industry, a utilization review firm, or another health care claims processing organization.
- Ability to execute cross-cutting projects requiring intense coordination, risk management, prioritization, and change management end-to-end.
- 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.
- Enjoy working in fast-paced and collaborative team environment.
- A minimum of three years in a project management capacity focused on complex and technically challenging projects;
- A minimum of two years working federal verification, auditing and/or improper payment programs; and
- Minimum holds a Bachelors degree from an accredited university or 5 years of relevant work experience.
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Medicaid/CHIP Payment Error Cycle Manager - Washington, United States - Serco North America
Description
Position Description :
Serco is seeking several cycle managers 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 Childrens 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; eligibility reviews, medical reviews, and data processing reviews, of selected state Medicaid and CHIP fee-for-services (FFS) and managed care claims; and supporting state and national reporting of payment error rate and development of corrective actions based on findings.
CMS uses a statistically valid methodology that samples a small subset of payments, then extrapolates to the universe of payments to determine the improper payment error rate. The process of sampling, reviewing payments, and calculating and reporting improper payment rates takes more than 2 years. PERM uses three-year cycle with 17-state rotation per cycle so that each state/district/territory is reviewed once every 3 years. CMS then calculates the national-level improper payment rate by using the latest improper payment rates from each state Medicaid program and CHIP from the most current cycle and the previous two cycles.
The three PERM cycle manager positions, each representing a cycle of states and review year (RY) would coordinate and manage cycle activities in the delivery of state and national improper payment error rate measurements. The cycle managers are responsible for the overall timeliness of the pre-cycle, cycle, and post cycle operations, managing against key operating risks.
Hybrid or full-time remote work. This position is contingent on contract award.
In this role, you will:
Competencies
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
Company Overview :Serco Inc. (Serco) is the Americas division of Serco Group, plc. In North America, Sercos 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: If you require an accommodation with the application process please email: - or call the HR Service Desk at , 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 -
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.
