Healthcare Coding & Fraud Analysis Expert (Remote)

General Dynamics Information Technology, Inc.; United States; Remoto; USD 78.000 - 105.000; Tempo pieno

Descrizione del lavoro

General Dynamics Information Technology, Inc. is seeking a Healthcare Coding Expert to support CMS HFPP initiatives. You will identify trends in medical claims, generate referrals, and help the Trusted Third Party and Partners reduce fraud, waste, and abuse.

Join a 50-person team, work on claims data analysis, develop analytic reports, and contribute to program integrity while complying with HIPAA and coding guidelines.

Competenze

• Bachelor's degree or equivalent year of work experience.
• 8+ years’ experience in healthcare claims analysis.
• Certified CPC/CCS certification from AAPC/AHIMA.
• Expertise in ICD-10, CPT, HCPCS coding.
• Experience with program integrity and fraud, waste, abuse activities.
• Strong knowledge of insurance regulations and reimbursement.
• Proficient in Microsoft Office; Tableau/Jira/Confluence a plus.

Mansioni

• Performs analytical tasks to identify fraud, waste, and abuse referrals and leads.
• Collaborate on the development of HFPP analytic reports.
• Drive outcome metrics for referrals shared with Partners.
• Analyze health claims data to generate study referrals and leads.
• Review medical claims for accuracy, completeness and compliance.
• Investigate insurance policies, coding guidelines, and reimbursement.
• Participate in QA to meet regulatory and policy standards.
• Respond to analytic output questions from stakeholders.
• May mentor junior professionals.

Conoscenze

Claims Data

Data Analysis

Microsoft Excel

Policy Analysis

Strategic Objectives

Formazione

Bachelor's degree or equivalent year of work experience

Strumenti

Tableau

Amazon WorkSpaces

Jira

Confluence

Descrizione del lavoro

General Dynamics Information Technology, Inc. is seeking a Healthcare Coding Expert to support CMS HFPP initiatives. You will identify trends in medical claims, generate referrals, and help the Trusted Third Party and Partners reduce fraud, waste, and abuse.

Join a 50-person team, work on claims data analysis, develop analytic reports, and contribute to program integrity while complying with HIPAA and coding guidelines.