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 is responsible for the provision of medical insight and expertise for Medicare claims review determinations and national coverage and payment issues under the direction of the Program Director.
Accountabilitites:
Interacts with medical societies, peer groups and other industry groups
Maintains a current working knowledge of medical practice standards and guidelines and related technology
Assists in the development of contractor policy, including necessary updating of policies, and the development of written guidelines used by the PSC CERT personnel
Provides medical insight and expertise for the claims reviews conducted by specialty physicians and medical review specialists
Makes claims determinations when warranted
Collaborates with management in advising CMS on national coverage and payment issues
Interacts with the Medical Directors at other CMS contractors to share information and coordinate contractor policy development when appropriate
Ensures compliance of specialty physicians with PSC procedures, guidelines and quality assurance activities
Ensures compliance with quality management system and ISO requirements
Coordinates medical specialty educational sessions for the staff when requested
Produces and submits required reports according to established content and guidelines
Effectively communicates with the customer, stakeholders and employees
Performs other projects and responsibilities as assigned by the Program Director
Skills, Knowledge, and Abilities:
Extensive knowledge of the Medicare program, particularly the coverage and payment rules of the Medicare program
Does not hold office in any association (medical or specialty society) that promotes the interest of medical or specialty society's participation in the Medicare program
Excellent organization, communication, and decision-making skills
Ability to work with others in a team environment
Ability to work with computer programs including MS Word and Excel
Education:
Board-certified doctor of medicine or doctor of osteopathy currently licensed and has practiced medicine for at least three years No adverse actions pending or taken against him/her by the Medicare, Medicaid, or any other Federal or State programs, any other medical insurance program, or medical licensing board
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 range for this position can be found at the top of this posting. This range is provided as a general guideline and represents a good faith estimate across all experience levels. Actual base salary will be determined by a variety of factors, including but not limited to, the scope of the role, relevant experience, job-related knowledge, education and training, key skills, and geographic market considerations. For roles available in multiple states, the range may vary to reflect differences in local labor markets. In addition to base salary, eligible positions may include other forms of compensation such as annual bonuses or long-term incentive opportunities.
Benefits - Comprehensible benefits for full-time employees (part-time employees 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
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 .
