Medical Claims Data Processing Review Team Lead (Medicaid/CHIP)

Location: Remote in the United States, with occasional required work at a Booz Allen or customer facility

Salary: $99,000–$225,000 annualized USD

Company

hirify.global provides consulting and technology services supporting government and organizational requirements.

What you will do

• Lead and mentor Medicaid and CHIP Data Processing review teams.
• Plan and oversee large-scale reviews of up to 16,150 fee-for-service and managed care claims across remote and onsite environments.
• Apply federal, state, industry, and organizational policies, procedures, and regulations.
• Provide subject matter expertise on complex determinations involving payment logic, capitation, third-party liability workflows, system discrepancies, and anomalies.
• Implement QA and QC procedures, resolve escalations, and deliver corrective training.
• Ensure accurate documentation and categorization of all Data Processing errors with defensible audit trails.

Requirements

• Experience leading and mentoring Medicaid and CHIP Data Processing review teams.
• Knowledge of MMIS, state payment, vendor, provider enrollment, PBM, dental, waiver, imaging, and financial systems.
• Knowledge of Medicaid and CHIP payment methodologies, including DRG, per-diem, capitation, PCCM, waiver payments, NEMT, HIPP, stop loss, and aggregate payment structures.
• Knowledge of PERM documentation standards, SMERF packet assembly, qualifier requirements, cross-referencing, and audit traceability.
• High school diploma or GED.
• Ability to work remotely in the United States and attend a Booz Allen or customer facility when required.

Nice to have

• Bachelor's degree.

Culture & Benefits

• Health, life, disability, financial, and retirement benefits.
• Paid leave, professional development, tuition assistance, work-life programs, and dependent care support.
• Recognition awards for exceptional performance and demonstration of company values.
• Virtual employees are generally expected to keep cameras on during meetings.
• Identity verification using biometrics is required during the hiring process.
• Use of AI tools during interviews and assessments is prohibited unless explicitly permitted.