Medical Claims Data Processing Review Team Lead
Booz Allen Hamilton•Washington, DC
•$99,000 - $225,000•Remote
About The Position
Develops, evaluates, documents, applies and implements policies, procedures or regulations to meet organizational, industry, and governmental requirements. Applies leading-edge principles, theories, and concepts; contributes to the development of new principles and concepts. Works on unusually complex problems and provides highly innovative solutions. Operates with substantial latitude for unreviewed action or decision; mentors or supervises employees in both company and technical competencies.
Requirements
- HS diploma or GED
Nice To Haves
- Bachelor's degree
Responsibilities
- Leading and mentoring Medicaid and CHIP Data Processing (DP) review teams, ensuring correct interpretation of federal and state requirements and consistent, PERM compliant review execution
- Managing large-scale review operations, including planning and overseeing workloads of up to 16,150 FFS and managed care claims across onsite and remote environments
- Providing SME-level guidance on complex DP determinations involving multi-system discrepancies, rate logic issues, capitation assignment, TPL workflows, RBS verification, and system anomalies
- Ensuring reviewers identify, document, and categorize all DP errors, including multiple errors per claim, using tools such as SMERF, review modules, and rate references
- Implementing and overseeing QA and QC procedures, resolving escalations across Tier levels, and delivering corrective training for reviewer knowledge gaps
Benefits
- health, life, disability, financial, and retirement benefits
- paid leave
- professional development
- tuition assistance
- work-life programs
- dependent care
- recognition awards program
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
High school or GED
