Healthcare Coding Analytics Lead for Fraud Detection

General Dynamics Information Technology, Inc.; United States; Remote; USD 100,000 - 140,000; Full time

Job summary

General Dynamics Information Technology, Inc. is seeking a Healthcare Coding Expert to support CMS initiatives. You will analyze healthcare claims, identify fraud indicators, and develop referrals for HFPP partners and trusted third parties.

The role requires CPC/CCS certification, extensive coding knowledge (ICD-10, CPT, HCPCS) and strong communication skills. You will work with Tableau, Jira, Confluence and MS Office in a large, mission-focused team.

Qualifications

• Bachelor's degree or equivalent year of work experience is required.
• 8+ years' experience in healthcare claims analysis.
• Certified CPC (AAPC) or CCS (AHIMA) certifications are required.
• Expertise in ICD-10, CPT, HCPCS and medical terminology.
• Experience with program integrity and healthcare fraud, waste, and abuse activities.

Responsibilities

• Identify fraud, waste, and abuse referrals and leads from HFPP Analytics.
• Collaborate on HFPP analytic reports development.
• Drive metrics for referrals and leads shared with Partners.
• Conduct health claims data analysis and generate study referrals and leads.
• Review medical claims for accuracy and coding guideline compliance.
• Investigate insurance policies and coding guidelines for compliance.
• Support QA to meet regulatory and policy standards.
• Respond to analytics questions from internal and external parties.
• Mentor and guide less experienced professionals.

Skills

CPC

CCS

Medical coding

ICD-10

CPT/HCPCS

Fraud analytics

HIPAA

Communication

Education

Bachelor's degree or equivalent experience

Tools

Tableau

Jira

Confluence

Microsoft Office

Job description

General Dynamics Information Technology, Inc. is seeking a Healthcare Coding Expert to support CMS initiatives. You will analyze healthcare claims, identify fraud indicators, and develop referrals for HFPP partners and trusted third parties.

The role requires CPC/CCS certification, extensive coding knowledge (ICD-10, CPT, HCPCS) and strong communication skills. You will work with Tableau, Jira, Confluence and MS Office in a large, mission-focused team.