Healthcare Coding & Fraud Analytics Specialist

General Dynamics Information Technology, Inc.; United States, Northern America, Americas; Presencial; USD 90.000 - 130.000; Jornada completa

Descripción de la vacante

General Dynamics Information Technology, Inc. is seeking a Healthcare Coding Expert to support CMS, focusing on identifying fraud, waste and abuse referrals and leading analytic efforts within HFPP.

The role requires deep expertise in medical coding (ICD-10, CPT, HCPCS), program integrity experience and strong communication skills, with a track record of working on complex data projects and cross-functional collaboration.

Formación

• Bachelor's degree or equivalent year of work experience
• 8+ years' experience in healthcare claims analysis
• Certified Professional Coder (CPC) or CCS designation
• Expertise in ICD-10, CPT, HCPCS and medical terminology
• Experience with program integrity, fraud, waste and abuse
• Strong knowledge of insurance regulations and reimbursement methodologies
• Excellent written and oral communication skills
• Proficient in Microsoft Office
• Experience with Tableau, Jira and Confluence; HIPAA knowledge

Responsabilidades

• Perform analytical tasks supporting HFPP program and generate referrals and leads
• Collaborate on HFPP analytic reports
• Drive outcome metrics for fraud, waste, and abuse referrals
• Support business development by analyzing health claims data and identifying opportunities
• Review and analyze medical claims for accuracy and compliance
• Identify fraud schemes and conduct policy research
• Participate in QA to ensure regulatory and policy adherence
• Respond to analytic output questions from stakeholders
• Mentor and guide junior team members

Conocimientos

Healthcare coding

Fraud analytics

Communication

MS Office

HIPAA knowledge

Problem solving

Leadership

Detail oriented

Educación

Bachelor's degree or equivalent

Herramientas

Tableau

Amazon WorkSpaces

Jira

Confluence

Descripción del empleo

General Dynamics Information Technology, Inc. is seeking a Healthcare Coding Expert to support CMS, focusing on identifying fraud, waste and abuse referrals and leading analytic efforts within HFPP.

The role requires deep expertise in medical coding (ICD-10, CPT, HCPCS), program integrity experience and strong communication skills, with a track record of working on complex data projects and cross-functional collaboration.