Healthcare Coding Expert (certified professional coder)

Responsibilities

• Perform analytical tasks to identify 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
• Review and analyze medical claims for accuracy, completeness, and compliance with insurance policies and coding guidelines
• Identify fraud, waste, and abuse schemes and conduct research and investigation of insurance policies and reimbursement criteria
• Participate in quality assurance initiatives to ensure adherence to regulatory requirements and industry standards
• Evaluate and respond to analytic output questions from internal and external parties
• May coach and provide guidance to less experienced professionals

Requirements

• Bachelors degree or equivalent year of work experience
• 8+ years of experience in healthcare claims analysis
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification
• Expertise in medical terminology and healthcare coding (ICD-10, CPT, HCPCS)
• Experience in program integrity and healthcare fraud, waste, and abuse activities
• Extensive knowledge of insurance regulations, reimbursement methodologies, and healthcare compliance requirements
• Expert level knowledge of Microsoft Office suite
• Experience with Tableau, Amazon WorkSpaces, Jira, and Confluence
• Working knowledge of HIPAA privacy and security rules

Preferred Qualifications

• Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) designation

About the Company

GDIT is a global technology and professional services company that delivers technology solutions and mission services to every major agency across the U.S. government, defense and intelligence community.