NCI: As the Benefit Integrity Manager (Benefit Integrity Mgr.) for AdvanceMed, a subsidiary of NCI, you will be responsible for the day to day management of the Part A & Home Health/ Hospice, Part B, DME, and Medicare/Medicaid benefit integrity teams. You will coordinate the development of all investigations and cases to ensure compliance with requirements set forth in the Task Order Statements of Work and the Program Integrity Manual as provided for by CMS, and will be a critical contributor in meeting AdvanceMed’s mission, “To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste, and abuse."
Highlights of Responsibilities:
Approves all law enforcement referrals and other significant stakeholder communications such as overpayment/education letters and requests for suspension.
Conducts regularly scheduled matrix reviews with the BI Supervisors and BI Analysts to ensure timely development and accurate identification of all applicable administrative action.
Coordinates communications with law enforcement and CMS related to requests to stay or delay administrative actions.
Prepares narrative of significant accomplishments and items for CMS attention for submission with monthly and ad hoc reporting as required by the Statements of Work.
Ensures that all investigations and cases are reviewed for application of all appropriate administrative actions (e.g. overpayment recoupment, suspension of payments, education, etc.).
Ensures that staff are aware of CMS requirements with regards to Fraud Alerts and Program Vulnerabilities Ensures that matrix reviews are conducted according to established policies and procedures.
Responsible for timely completion of employee performance assessments and conducts employee counseling, as needed.
Minimum of four (4) years of supervisory/management experience across multiple Medicare benefit types.
Minimum three (3) years experience in Medicare medical/utilization review and/or benefits integrity activities.
Knowledge of ZPIC contract requirements.
Knowledge and skills to plan, conduct, and supervise work to be completed.
Exceptional oral and written communication and negotiation skills.
Strong leadership, organizational and planning skills.
Excellent critical thinking and negotiation skills.
Ability to handle multiple and conflicting priorities.
Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program.
Must have and maintain a valid driver’s license issued by the state of residence.
At NCI, we’re more than just a paycheck…
We offer significant opportunity for growth at NCI – Adding more and more employees and company locations nationwide, we continue to seek top talent to ensure our path of innovation, growth and unmatched customer experience. We reward our employees with competitive compensation, flexible time off, retirement plan with company match and much more…
MEDICAL/DENTAL/VISION PROGRAMS - NCI offers three medical plan options to meet the personal health needs and budgets of our full-time employees and their families. All plans provide our employees and their eligible dependents with major medical and prescription drug coverage. The dental plan provides coverage options so as to ensure our full-time employees and their eligible dependents are able to follow a regularly scheduled program of dental care with their providers of choice. A vision maintenance plan offers a cost-savings option for our full-time employees and their families in need of comprehensive annual eye exams, prescription glasses, and contact lenses.
STOCK & WEALTH - NCI’s 401(k) Profit Sharing Plan is eligible to all full-time and regular part-time employees. Employees may elect to have contributions invested in any of the 15 different investment funds, five retirement-date-based funds, or three different portfolio options available under the plan. The company matching contribution is equal to 50% of employee elected pre-tax contributions up to 6% of eligible pay, subject to the IRS maximum.
LIFE INSURANCE - NCI provides company paid Basic Life/ AD&D Insurance Coverage. The basic coverage benefit is equal to one times (1X) an employee's annual base salary. Employees may also opt for a generous flat rate insurance coverage. For coverage above the company-provided limits, employees may purchase supplemental insurance coverage for themselves and their family members.
WORK/LIFE BALANCE - All employees are eligible for additional programs including Paid Time Off (PTO).
It is your turn… Choose your career path and become part of the NCI team where you will be valued for your unique skills and capabilities and where you will be rewarded for key contributions to NCI and our customers.
- Flexible Spending Programs
- Employee Assistance Program (EAP) for employees and their immediate family
- Health Club Reimbursement through NCI’s Wellness Program
Make the commitment and take the next step towards joining the NCI Team. Our application process will take approximately 5-10 minutes to complete.
If you do not meet the minimum qualifications for this position, please review our current openings now and in the future. Thank you for your interest in NCI!
It is the policy of NCI to provide equal opportunity in recruiting, hiring, training, and promoting individuals in all job categories without regard to race, color, religion, national origin, gender, age, sexual orientation, disability or veteran status.
The information above has been designed to indicate the general nature and level of work performed by employees within the classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this position.
NCI Information Systems, Inc. - 22 months ago
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