Senior Healthcare Coding & Analytics Specialist (Remote)

General Dynamics Information Technology, Inc.; Virginia (MN); Hybrid; USD 78,000 - 105,000; Full time

Job summary

General Dynamics Information Technology, Inc. is seeking a Healthcare Coding Expert to support CMS with analytics on fraud, waste and abuse. You will identify trends, create leads, and collaborate with partners and the Trusted Third Party to improve program integrity.

The role requires 8+ years in healthcare claims analysis, CPC or CCS certification, and strong coding knowledge (ICD-10, CPT, HCPCS). Remote work options and travel up to 25% are part of the position.

Qualifications

• Bachelor's degree or equivalent with 8+ years in healthcare claims analysis.
• CPC (AAPC) or CCS (AHIMA) certification.
• Expertise in medical terminology and ICD-10, CPT, HCPCS coding.
• Experience in program integrity and fraud, waste & abuse activities.
• Knowledge of insurance regulations, reimbursement methods, and compliance.

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

Tools

Tableau

Amazon WorkSpaces

Jira

Confluence

Job description

General Dynamics Information Technology, Inc. is seeking a Healthcare Coding Expert to support CMS with analytics on fraud, waste and abuse. You will identify trends, create leads, and collaborate with partners and the Trusted Third Party to improve program integrity.

The role requires 8+ years in healthcare claims analysis, CPC or CCS certification, and strong coding knowledge (ICD-10, CPT, HCPCS). Remote work options and travel up to 25% are part of the position.