Quality Assurance Clerk/Technician

About the role

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.

Responsibilities

• Initiate and monitor identified quality assurance activities related to the CERT program with a focus on Inter-Rater Reliability (IRR) and periodic audit requirements, including compliance with contract deliverables Statement of Work (SOW), internal/external performance requirements and continual improvement.
• Prepare and monitor the IRR process from sample initiation through Panel preparation.
• Maintain documents/records/files related to quality assurance activities (with a focus on IRR, periodic audit preparation/materials collection; licensure confirmation; task tracking).
• Provide quality assurance data and information to the QA Manager for task order reports.
• Input data into identified computer systems with a focus on the IRR module components.
• Effectively communicate with management and employees (via email and/or phone, Feedback form development, excel data).
• Comply with departmental policies and procedures.
• Perform other projects or responsibilities as assigned by department manager (in collaboration with another department management).

Qualifications

• High school diploma
• At least 3 years of work experience in a medical office or medical records setting
• Flexible and able to adjust to changing priorities
• Effective time management and prioritization skills; able to multitask and work independently with limited oversight
• Knowledge of medical record processing
• Knowledge of medical terminology
• Able to work under pressure and within designated time constraints
• Adept with multiple software including MS Office, Excel, Outlook, Zoom, Teams
• Additional Desired Qualifications: Bachelor’s degree in Public Health or a public administration related field

Benefits

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.