Medi-Medi Task Order Program Director

StrategicHealthSolutions, LLC
Medi-Medi Task Order Program Director

Description: 

Direct activities of a Zone Program Integrity Contractor (ZPIC) as a contractor for the Centers for Medicare & Medicaid Services (CMS). Promote the integrity of the Medicare and Medicaid programs by identifying, stopping and preventing Medicare and Medicaid fraud, waste and abuse and referring instances of potential fraud, waste and abuse to the appropriate law enforcement agencies.

Job Responsibilities:

Supervise team members ensuring members follow policies and procedures for ZPIC Medi-Medi workload.

Assist team when necessary in coordination of appeal case processing and workload adjustment.

Act as liaison for team members with other departments.

Conduct periodic quality review of team members’ work products.

Review Medicare and or Medi-Medi Data Analysis progress reports and other written submissions & presentations.

Conduct periodic team meetings to discuss team related issues and concerns. 

Perform other duties as assigned by the ZPIC Project Management related to Medi-Medi project.

Monitor and report on project management progress.

Direct and prepare deliverables and required reports.

Direct and prepare management presentations.

Experience:

At least two (2) years experience with Medi-Medi data.

Ability to successfully conduct an internet search using Boolean or other search techniques.

Excellent organizational, interpersonal, written, and verbal communication skills.

Ability to perform comfortably in a fast-paced, deadline-oriented work environment.

Ability to successfully execute many complex tasks simultaneously.

Ability to develop and maintain excellent relationships with appropriate law enforcement personnel.

Ability to work as a team member, as well as ability to provide instruction and guidance to team members.

Knowledge of data analysis processes and procedures.

At least two (2) years of specific experience in Medicare Program Integrity Work.

At least two (2) years of Medicare, Medicaid, or Medi-Medi data analysis experience.

At least three (3) years of experience in Medicare claim types A,B,C,D, DMEOS, and Regional Home Health.

Experience with MS Project, MS Word, Excel, SAS, knowledge of FID.

Comprehensive understanding of the restrictions and requirements of data matching in relationship to the Medi-Medi project.

Ten or more years of professional experience with at least three (3) years as a manager responsible for managing complex systems and work flow.

Educational Requirements:

A bachelor’s degree from an accredited institution, plus a master’s degree from an accredited institution or substitution of 4 additional years of related work experience in lieu of the master’s degree.