Healthcare Fraud & Claims Analytics Lead (Remote)

General Dynamics Information Technology, Inc.; Yorktown (VA); Remote; USD 78,000 - 105,000; Full time

Job summary

General Dynamics Information Technology, Inc. is seeking a Healthcare Coding Expert to support CMS and HFPP analytics. You will identify trends in data, create referrals, and help reduce fraud, waste, and abuse within healthcare claims.

You will join a 50-person team supporting the TTP, with opportunities to mentor others and collaborate on analytic reports while ensuring regulatory and company policy compliance.

Qualifications

• Bachelor's degree or equivalent year of work experience.
• 8+ years’ experience in healthcare claims analysis.
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).
• Expertise in ICD-10, CPT, HCPCS coding.

Responsibilities

• Performs analytical tasks in support of HFPP program, including identifying 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.
• May perform business development activities including analyzing health claims data, generating study referrals and leads, developing provider background profiles, and identifying opportunities for Partner collaboration meetings.
• Reviews and analyzes 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.
• Participates in quality assurance initiatives to ensure deliverable adherence to regulatory requirements, medical and company policies and industry standards.
• Evaluates and responds to analytic output questions from internal and external parties.
• May coach and provide guidance to less experienced professionals.

Skills

Claims Data

Data Analysis

Microsoft Excel

Policy Analysis

Strategic Objectives

Education

Bachelor's degree or equivalent year of work experience

Tools

Microsoft Excel

Job description

General Dynamics Information Technology, Inc. is seeking a Healthcare Coding Expert to support CMS and HFPP analytics. You will identify trends in data, create referrals, and help reduce fraud, waste, and abuse within healthcare claims.

You will join a 50-person team supporting the TTP, with opportunities to mentor others and collaborate on analytic reports while ensuring regulatory and company policy compliance.