Remote Healthcare Coding & Fraud Analytics Lead

General Dynamics Information Technology, Inc.

Virginia

Remote

USD 78,000 - 105,000

Full time

10 days ago

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Job summary

General Dynamics Information Technology, Inc. is seeking a Healthcare Coding Expert to support CMS through HFPP analytics and referrals.

You will identify trends in data and create leads for HFPP members and trusted third party partners, joining a 50-person team dedicated to reducing fraud, waste, and abuse in healthcare data. The role requires deep expertise in medical coding, claims analysis, and HIPAA compliance, with responsibilities spanning data reviews, reports, and potential business

Qualifications

Bachelor's degree or equivalent year of work experience.
8+ years’ experience in healthcare claims analysis.
CPC or CCS certification.
Expertise in ICD-10, CPT, HCPCS coding.
Experience with program integrity and healthcare fraud activities.
Strong communication and Office Suite skills; experience with Tableau/Jira/Confluence.

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.