CERT Coordinator - 300055

Job Summary

The Comprehensive Error Rate Testing (CERT) Coordinator is responsible for activities which promote the reduction of the CERT error rate such as identifying and analyzing claim issues identified by the CERT contractor that relate to coding, billing, and Medicare coverage regulations. This position is responsible for providing timely and quality education to Medicare service providers through a variety of ways which may include telephone and written communications, articles, presentations, and face to face visits.

Key Performance Indicators

• Identifies coding, billing, and coverage vulnerabilities through the CERT program
• Coordinates and provides innovative and effective education to Medicare service providers
• Completes required administrative duties associated with CERT deadlines

Essential Functions

Key Duties/Responsibilities/Accountabilities

• Analyzes raw data and identifies vulnerabilities.
• Prepares trending analysis and reports such as Improper Payment Reduction Strategy (IPRS).
• Prepares educational materials and coordinates educational activities.
• Provides timely and quality education.
• Creates and maintains functional process documentation.
• Collaborates with Provider Outreach and Education, Medical Review, Appeals, and other departments.
• Maintains tracking mechanisms and databases utilized to track and monitor CERT related activities.
• Participates in and actively supports internal/external committee meetings such as Medicare Carrier Advisory Committee (CAC), Coverage meetings, and Ask the Contractor Teleconferences.
• Maintains working knowledge of Centers for Medicare & Medicaid Services (CMS) regulations, processing guidelines, and processing systems.

Non-Essential Duties and Functions

• Other duties as assigned
• Special projects as assigned.

Requirements

Qualifications

Minimum Qualifications:

• High school GED or diploma
• 2 years' claims processing experience or 2 years' experience with research and resolution of claim issues (edits, audits, reason codes, etc.)
• Excellent verbal and written communication skills
• Effective and professional presentation skills
• Demonstrated problem solving skills
• Ability to complete tasks with minimal management oversite
• Ability to work independently and in a team environment

Preferred Qualifications:

• Associate's degree in a medical field
• CPC certification
• Advanced Microsoft Excel skills
• Ability to create and maintain Access Databases
• Experience with setting up Go-To meetings

Environment and Cognitive/Physical Demands

• Office Environment
• Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve
• Requires prolonged sitting and telephone usage
• Requires the use of office equipment such as computer terminals, telephones, copiers and printers
• Infrequent lifting up to 15 pounds
• Infrequent stooping
• Travel up to 25%

Segregation of Duties

Every employee is responsible to perform their duties and responsibilities in accordance with Noridian values, policies and procedures, including but not limited to, Segregation of Duties Principles, HIPAA Security and Privacy, CMS requirements, the Noridian Compliance Program, and any other applicable laws, rules and regulations.

Statement of Other Duties

This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions. Employees may be requested to perform job related tasks other than those specifically listed in this description, and may be required to perform any task requested by the supervisor or by management.

CMS Access Compliance and Regulation Contingency Statement

Some positions require compliance with (i) federal and agency-specific regulations and related clauses included in NHS's prime contracts with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card.

Other Information

Job Posting Policy 6.05

New employees with Noridian Healthcare Solutions will be eligible to apply for positions within their assigned department after successfully completing a 90-day review. For positions outside your department, you must attain a minimum of six months of service before you can apply.

Equal Employment Opportunity

Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

For questions, please email careers@noridian.com.

This job posting will be closed 01/25/2019 at 8:00AM CST. No further applications will be considered.