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Job Description
Position Description & Qualifications
The Centers for Medicare & Medicaid Services (CMS) Comprehensive Error Rate Testing (CERT) program plays a vital role in safeguarding the integrity of the Medicare Fee-for-Service (FFS) program by ensuring that taxpayer-funded healthcare payments are accurate, appropriate, and compliant with federal requirements. Supporting CMS's obligations under the Payment Integrity Information Act (PIIA), the program uses statistically valid sampling and independent medical review of claims to identify improper payments and measure program performance. The insights generated through CERT enable CMS to strengthen accountability, improve healthcare delivery practices, and drive corrective actions that protect both beneficiaries and public funds. Through this work, the CERT program helps uphold transparency, stewardship, and trust in one of the nation's most critical healthcare systems.
This position requires experience in conducting detailed research to validate enrollments of providers in the Medicare System. The Provider Enrollment Validator must be able to understand the CMS PESCOS (Provider Enrollment, Chain, and Ownership System) Database and the various other websites required to verify that providers are appropriately enrolled to practice in the Medicare system.
As a Medical Records Provider Enrollment/First Touch Specialist, you will:
To be successful in this role, you must have:
Additional desired qualifications:
If you are interested in working with a passionate Serco team, then submit your application now for immediate consideration. It only takes a few minutes and could change your career!
Company Overview
Serco Inc. (Serco) is the Americas division of Serco Group, plc. In North America, Serco's 9,000+ employees strive to make an impact every day across 100+ sites in the areas of Defense, Citizen Services, and Transportation. We help our clients deliver vital services more efficiently while increasing the satisfaction of their end customers. Serco serves every branch of the U.S. military, numerous U.S. Federal civilian agencies, the Intelligence Community, the Canadian government, state, provincial and local governments, and commercial clients. While your place may look a little different depending on your role, we know you will find yours here. Wherever you work and whatever you do, we invite you to discover your place in our world. Serco is a place you can count on and where you can make an impact because every contribution matters.
To review Serco benefits please visit: https://careers.serco-na.com/us/en/what-we-offer . If you require an accommodation with the application process please email: careers@serco-na.com or call the HR Service Desk at 800-628-6458, option 1. Please note, due to EEOC/OFCCP compliance, Serco is unable to accept resumes by email.
Candidates may be asked to present proof of identify during the selection process. If requested, this will require presentation of a government-issued I.D. (with photo) with name and address that match the information entered on the application. Serco will not take possession of or retain/store the information provided as proof of identity. For more information on how Serco uses your information, please see our Applicant Privacy Policy and Notice.
Serco does not accept unsolicited resumes through or from search firms or staffing agencies without being a contracted approved vendor. All unsolicited resumes will be considered the property of Serco and will not be obligated to pay a placement or contract fee. If you are interested in becoming an approved vendor at Serco, please email Agencies@serco-na.com .
Serco is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.
Pay Transparency
Our Total Rewards package includes competitive pay, performance-based incentives, and benefits that promote well-being and work-life balance-so you can thrive both professionally and personally. Eligible employees also gain access to a wide range of benefits from comprehensive health coverage and health savings accounts to retirement plans, life and disability insurance, and time-off programs that support work-life balance. Program availability may vary based on factors such as contract type, location, hire date, and applicable collective bargaining agreements.
Salary range: The hourly amount for this position can be found at the top of this posting. This role is covered by the Service Contract Act. For positions on this contract, we will pay the prevailing wage rate for the location in which the employee is working, as determined by the Department of Labor and the Wage Determination (WD). The wage rate will vary depending on the locality. Additionally, you will receive Health and Welfare Benefits based on the WD for the contract. Benefits - Comprehensible benefits for full-time employees (part-time members receive a limited package tailored to their role):
To review all Serco benefits please visit: https://careers.serco-na.com/us/en/about-us .
Serco complies with all applicable state and local leave laws, including providing time off under the Colorado Healthy Families and Workplaces Act for eligible Colorado residents, in alignment with our policies and benefit plans. The application window for this position is for no more than 60 days. We encourage candidates to apply promptly after the posting date, as the position may close earlier if filled or if the application volume exceeds expectations. Please submit applications exclusively through Serco's external (or internal) career site. If an applicant has any concerns with job posting compliance, please send an email to: careers@serco-na.com .
The Centers for Medicare & Medicaid Services (CMS) Comprehensive Error Rate Testing (CERT) program plays a vital role in safeguarding the integrity of the Medicare Fee-for-Service (FFS) program by ensuring that taxpayer-funded healthcare payments are accurate, appropriate, and compliant with federal requirements. Supporting CMS's obligations under the Payment Integrity Information Act (PIIA), the program uses statistically valid sampling and independent medical review of claims to identify improper payments and measure program performance. The insights generated through CERT enable CMS to strengthen accountability, improve healthcare delivery practices, and drive corrective actions that protect both beneficiaries and public funds. Through this work, the CERT program helps uphold transparency, stewardship, and trust in one of the nation's most critical healthcare systems.
This position requires experience in conducting detailed research to validate enrollments of providers in the Medicare System. The Provider Enrollment Validator must be able to understand the CMS PESCOS (Provider Enrollment, Chain, and Ownership System) Database and the various other websites required to verify that providers are appropriately enrolled to practice in the Medicare system.
As a Medical Records Provider Enrollment/First Touch Specialist, you will:
- Initial Medical Review, annotating and highlighting relevant information, identifying missing documents that need to be requested for final review
- Conduct in-depth analysis utilizing research skills in order to determine the validity of provider enrollments using the required government resources and websites.
- Be able to determine and fail validations when the information found is not in compliance with Medicare protocols.
- Sort information, formats, and abstraction for a variety of medical settings.
- Provide electronic documentation of findings and conclusions with determination of verification.
- Review and completes the required number of claims in accordance to established production standards for the project.
- Communicate internally with all levels of CERT, as required.
- Participate in Quality Assurance when required.
- Comply with departmental policies and procedures.
- Comply with Program Integrity Manual (PIM) and Statement of Work (SOW) guidelines and CMS directives and regulations pertaining to integrity, fraud and the handling and disclosure of information.
- Attend departmental and required education and training programs.
- Perform other projects or duties as assigned by the Medical Record Manager, or Supervisor.
To be successful in this role, you must have:
- Associates Degree or equivalent experience in relevant areas of expertise.
- 4 years medical records experience.
- Excellent oral and written communication skills.
- Knowledge of and the ability to use Microsoft Word, Excel, and Internet applications.
- Team-oriented and able to implement the operational strategies and procedures that will help achieve the overall quality and production goals of the Medical Review unit.
- Ability to efficiently organize and manage workload and assignments
Additional desired qualifications:
- At least 1 year of experience in clinical documentation review/abstraction.
- Medical claim review experience is desirable
- Demonstrated knowledge of ICD-9-CM, ICD-10-CM, CPT-4, and HCPCS Level II coding applications desirable
If you are interested in working with a passionate Serco team, then submit your application now for immediate consideration. It only takes a few minutes and could change your career!
Company Overview
Serco Inc. (Serco) is the Americas division of Serco Group, plc. In North America, Serco's 9,000+ employees strive to make an impact every day across 100+ sites in the areas of Defense, Citizen Services, and Transportation. We help our clients deliver vital services more efficiently while increasing the satisfaction of their end customers. Serco serves every branch of the U.S. military, numerous U.S. Federal civilian agencies, the Intelligence Community, the Canadian government, state, provincial and local governments, and commercial clients. While your place may look a little different depending on your role, we know you will find yours here. Wherever you work and whatever you do, we invite you to discover your place in our world. Serco is a place you can count on and where you can make an impact because every contribution matters.
To review Serco benefits please visit: https://careers.serco-na.com/us/en/what-we-offer . If you require an accommodation with the application process please email: careers@serco-na.com or call the HR Service Desk at 800-628-6458, option 1. Please note, due to EEOC/OFCCP compliance, Serco is unable to accept resumes by email.
Candidates may be asked to present proof of identify during the selection process. If requested, this will require presentation of a government-issued I.D. (with photo) with name and address that match the information entered on the application. Serco will not take possession of or retain/store the information provided as proof of identity. For more information on how Serco uses your information, please see our Applicant Privacy Policy and Notice.
Serco does not accept unsolicited resumes through or from search firms or staffing agencies without being a contracted approved vendor. All unsolicited resumes will be considered the property of Serco and will not be obligated to pay a placement or contract fee. If you are interested in becoming an approved vendor at Serco, please email Agencies@serco-na.com .
Serco is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.
Pay Transparency
Our Total Rewards package includes competitive pay, performance-based incentives, and benefits that promote well-being and work-life balance-so you can thrive both professionally and personally. Eligible employees also gain access to a wide range of benefits from comprehensive health coverage and health savings accounts to retirement plans, life and disability insurance, and time-off programs that support work-life balance. Program availability may vary based on factors such as contract type, location, hire date, and applicable collective bargaining agreements.
Salary range: The hourly amount for this position can be found at the top of this posting. This role is covered by the Service Contract Act. For positions on this contract, we will pay the prevailing wage rate for the location in which the employee is working, as determined by the Department of Labor and the Wage Determination (WD). The wage rate will vary depending on the locality. Additionally, you will receive Health and Welfare Benefits based on the WD for the contract. Benefits - Comprehensible benefits for full-time employees (part-time members receive a limited package tailored to their role):
- Medical, dental, and vision insurance
- Robust vacation and sick leave benefits, and flexible work arrangements where permitted by role or contract
- 401(k) plan that includes employer matching funds
- Tuition reimbursement program
- Life insurance and disability coverage
- Optional coverages that can be purchased, including pet insurance, home and auto insurance, additional life and accident insurance, critical illness insurance, group legal, ID theft protection
- Birth, adoption, parental leave benefits
- Employee Assistance Plan that includes counseling conditions
- Specific benefits are dependent upon the specific contract as well as whether the position is covered by a collective bargaining agreement or Service Contract Labor Standards.
To review all Serco benefits please visit: https://careers.serco-na.com/us/en/about-us .
Serco complies with all applicable state and local leave laws, including providing time off under the Colorado Healthy Families and Workplaces Act for eligible Colorado residents, in alignment with our policies and benefit plans. The application window for this position is for no more than 60 days. We encourage candidates to apply promptly after the posting date, as the position may close earlier if filled or if the application volume exceeds expectations. Please submit applications exclusively through Serco's external (or internal) career site. If an applicant has any concerns with job posting compliance, please send an email to: careers@serco-na.com .
group id: 10118317
