Medicaid Claims Data Review Lead — QA & Compliance

Phase2 Technology; Washington (District of Columbia); On-site; USD 99,000 - 225,000; Full time

Job summary

Booz Allen is seeking a Medical Claims Data Processing Review Team Lead to guide Medicaid and CHIP data processing reviews, mentor teams, and ensure PERM-compliant execution across onsite and remote environments.

You will apply knowledge of MMIS, multisystem payment methods, and cross-system validation to drive QA/QC, train reviewers, and resolve discrepancies with a focus on governance and accuracy.

Qualifications

• Experience leading Medicaid and CHIP Data Processing review teams and ensuring PERM-compliant execution.
• Experience managing large-scale review operations across onsite and remote environments.
• Knowledge of MMIS, state payment systems, vendor/provider enrollment systems.
• Knowledge of Medicaid/CHIP payment methodologies (DRG, capitation, wrap payments, NEMT, HIPP, stop loss).
• Knowledge of PERM documentation standards (SMERF, qualifiers, audit traceability).
• Ability to provide SME guidance on complex DP determinations across multi-system discrepancies.
• Ability to implement QA/QC procedures and deliver corrective training.

Skills

Team leadership

Medicaid/DP review

Project planning

QA/QC oversight

SMERF knowledge

Complex DP determinations

Remote/Onsite management

Education

HS diploma or GED

Bachelor's degree

Tools

SMERF system

Rate references

Job description

Booz Allen is seeking a Medical Claims Data Processing Review Team Lead to guide Medicaid and CHIP data processing reviews, mentor teams, and ensure PERM-compliant execution across onsite and remote environments.

You will apply knowledge of MMIS, multisystem payment methods, and cross-system validation to drive QA/QC, train reviewers, and resolve discrepancies with a focus on governance and accuracy.