Description
GDIT's Federal Health Division is hiring a Healthcare Coding Expert to support the Centers for Medicare and Medicaid (CMS). You will be part of a 50-person team supporting the Trusted Third Party (TTP) which was established in 2012 to reduce fraud, waste and abuse in healthcare data.
Key Responsibilities:
- Perform analytical tasks to identify fraud, waste, and abuse referrals and leads from HFPP Analytics
- Collaborate on the development of HFPP analytic reports
- Drive outcome metrics related to fraud, waste, and abuse referrals and leads shared with Partners
- Review and analyze medical claims to determine accuracy, completeness and compliance with insurance policies, coding guidelines and reimbursement criteria
- Identify fraud, waste, and abuse schemes and conduct research and investigation of insurance policies, coding guidelines and reimbursement criteria
- Participate in quality assurance initiatives to ensure deliverable adherence to regulatory requirements, medical and company policies and industry standards
- Evaluate and respond to analytic output questions from internal and external parties
- Coach and provide guidance to less experienced professionals
Requirements:
- Bachelor's degree or equivalent year of work experience
- 8+ years' experience in healthcare claims analysis
- 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
- Extensive knowledge of insurance regulations, reimbursement methodologies and healthcare compliance requirements
- Strong oral and written communication skills
- Expert level knowledge of Microsoft Office suite
- Experience with Tableau, Amazon WorkSpaces, Jira, and Confluence
- Working knowledge of HIPAA privacy and security rules
Preferred Qualifications:
- Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) designation
Benefits:
- Medical plan options
- Dental plan options
- Vision plan
- 401(k) plan
- Paid time off plans
- Holidays
- Paid parental, military, bereavement and jury duty leave
- Short and long-term disability benefits
- Life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance