Req ID: RQ210039
Type of Requisition: Regular
Clearance Level Must Be Able to Obtain: None
Public Trust/Other Required: None
Job Family: Ancillary Health
Skills:
Healthcare Fraud (Inactive),Insurance Fraud Investigations,Insurance Regulations,Medical Billing and Coding,Technical Writing Documentation
Certifications:
Certified Professional Coder (CPC) | American Academy of Professional Coders (AAPC) - American Academy of Professional Coders (AAPC), Certified Coding Specialist (CCS) | American Health Information Management Association (AHIMA) - American Health Information Management Association (AHIMA)
Experience:
8 + years of related experience
Job Description:
HEALTHCARE Coding Subject Matter Expert
At GDIT, people are our differentiator. As a Healthcare Coding Subject Matter Expert (SME) supporting the Centers for Medicare and Medicaid (CMS), you will be trusted to research healthcare fraud trends and draft supporting documenting for cross payer analytics for the Healthcare Fraud Prevention Partnership (HFPP) members (Partner) and the Trusted Third Party (TTP).
You will be part of a 50-person team supporting the TTP which was established in 2012 to reduce fraud, waste and abuse in healthcare data.
We are GDIT. The people supporting and securing some of the most complex government, defense, and intelligence projects across the country. We ensure today is safe and tomorrow is smarter. Our work has meaning and impact on the world around us, but also on us, and that's important.
GDIT is your place. You make it your own by embracing autonomy, seizing opportunity, and being trusted to deliver your best every day.
We think. We act. We deliver. There is no challenge we can't turn into opportunity. Our work depends on a Healthcare Coding SME joining our team to support CMS Trusted Third Party activities.
Roles and Responsibilities
Reviews and analyzes medical claims to determine accuracy, completeness and compliance with insurance policies, coding guidelines and reimbursement criteria.
Verifies the accuracy of diagnosis and procedure codes in claims data, ensuring alignment with medical policies and industry coding standards.
Identify fraud, waste, and abuse schemes and conduct research and investigation of insurance policies, coding guidelines and reimbursement criteria
Participate in HFPP analytics development in cross-payer environments through creating supporting documents, presentations, and deliverables
Collaborates with Healthcare Fraud Prevention Partnership (HFPP) Partners to obtain additional information, clarification or documentation needed to review fraud, waste, and abuse schemes.
Participates in quality assurance initiatives to ensure deliverable adherence to regulatory requirements, medical and company policies and industry standards.
Authors analytic output for non-technical audience
Evaluates and responds to analytic output questions from internal and external parties.
May coach and provide guidance to less experienced professionals.
Required Education and Experience
BA/BS or equivalent experience
8+ years' experience in health care claims analysis
8+ years' experience in fraud, waste, and abuse investigations
Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC) or Certified Coding Specialist (CCS) through the American Health Information Management Association (AHIMA)
Expertise in medical terminology and all healthcare coding (e.g., ICD-10, CPT, HCPCS)
Experience in program integrity and healthcare fraud, waste, and abuse activities, including edits, audits, pre-payment and post-payment review, investigations, referrals
Extensive knowledge of insurance regulations, reimbursement methodologies and healthcare compliance requirements.
Strong oral and written communication skills with the ability to present to management level staff.
Expert level knowledge of Microsoft Office suite.
Working knowledge of HIPAA privacy and security rules.
Desired Qualifications
Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) designation strongly desired.
Experience with Tableau, Amazon WorkSpaces, Jira, and Confluence.
Soft Skills qualifications
Ability to communicate technical and non-technical language to technical and non-technical audiences
Ability to prioritize multiple tasks to meet established deadlines and satisfy internal and external customer demands
Strong decision-making skills and a demonstrated history of established leadership qualities as well as proven organizational skills.
Commitment to confidentiality, privacy, and professionalism.
Ability to independently follow through on problems.
Detail oriented and ability to prioritize multiple tasks and work under pressure.
Ability to work on complex projects with general direction and minimal guidance
Ability to build effective relationships, demonstrating strong interpersonal skills.
Exhibit high initiative to get things accomplished; high organizational ability to juggle multiple priorities.
Ability to perform well and achieve goals both in a team environment, with staff at all levels, and independently.
Security Clearance Level
Must be able to obtain a public trust clearance
Location: Remote
GDIT IS YOUR PLACE
At GDIT, the mission is our purpose, and our people are at the center of everything we do.
Growth: AI-powered career tool that identifies career steps and learning opportunities
Support: An internal mobility team focused on helping you achieve your career goals
Rewards: Comprehensive benefits and wellness packages, 401K with company match, and competitive pay and paid time off
Flexibility: Full-flex work week to own your priorities at work and at home
Community: Award-winning culture of innovation and a military-friendly workplace
GDITFedHealthJobs
The likely salary range for this position is $74,800 - $101,200. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.
Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year. Paid leave and paid holidays are prorated based on the employee's date of hire. The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most.
We are GDIT. A global technology and professional services company that delivers consulting, technology and mission services to every major agency across the U.S. government, defense and intelligence community. Our 30,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 50 countries worldwide, offering leading capabilities in digital modernization, AI/ML, Cloud, Cyber and application development. Together with our clients, we strive to create a safer, smarter world by harnessing the power of deep expertise and advanced technology.
Join our Talent Community to stay up to date on our career opportunities and events at https://gdit.com/tc.
Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans
