Investigative Analyst (CMS Healthcare Claims)

General Dynamics Information Technology•USA VA Home Office (VAHOME), VA

22h•$77,775 - $105,225•Remote

About The Position

GDIT is hiring a healthcare claims Investigative Analyst to support the Centers for Medicare and Medicaid (CMS). The role involves identifying trends in data and creating leads and referrals for Healthcare Fraud Prevention Partnership (HFPP) members and the Trusted Third Party (TTP). The analyst will be part of a 50-person team supporting the TTP, which was established in 2012 to reduce fraud, waste, and abuse in healthcare data. This position is remote, and work visa sponsorship will not be provided.

Requirements

BA/BS or equivalent experience
8+ years’ experience in health care claims analysis (equivalent work experience will be considered in lieu of degree)
Strong oral and written communication skills with the ability to present to management level staff.
Expert level knowledge of Microsoft Office suite.
Experience with Tableau, Amazon WorkSpaces, Jira, and Confluence.
Working knowledge of HIPAA privacy and security rules.
Strong decision-making skills and a demonstrated history of established leadership qualities as well as proven organizational skills.
Commitment to confidentiality, privacy, and professionalism.
Ability to independently follow through on problems.
Detail oriented and ability to prioritize multiple tasks and work under pressure.
Ability to work on complex projects with general direction and minimal guidance
Ability to build effective relationships, demonstrating strong interpersonal skills.
Exhibit high initiative to get things accomplished; high organizational ability to juggle multiple priorities.
Ability to perform well and achieve goals both in a team environment, with staff at all levels, and independently.

Nice To Haves

Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) designation strongly desired.
Certified clinical coding

Responsibilities

Performs analytical tasks in support of HFPP program, including identifying fraud, waste, and abuse referrals and leads from HFPP Analytics
Conduct data mining across the partnership utilizing internal tools
Collaborate on the development of HFPP analytic reports
Develops fraud, waste, and abuse referrals and leads for Partners based on HFPP analytic reports
Drive outcome metrics related to fraud, waste, and abuse referrals and leads shared with Partners
Interacts regularly with Partners regarding referrals and leads identified
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

Benefits

401K with company match
Competitive pay
Paid time off
Full flex work weeks
Variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave.
15 days of paid leave per calendar year to be used for vacations, personal business, and illness
10 paid holidays per year
Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees.
Short and long-term disability benefits
Life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance