Healthcare Coding Expert

Responsibilities

• Perform analytical tasks to identify fraud, waste, and abuse referrals and leads
• Collaborate on the development of HFPP analytic reports
• Review and analyze medical claims for accuracy, completeness, and compliance with coding guidelines
• Conduct research and investigation of insurance policies and reimbursement criteria
• Participate in quality assurance initiatives to ensure adherence to regulatory requirements
• Evaluate and respond to analytic output questions from internal and external parties

Requirements

• Bachelors degree or equivalent work experience
• 8+ years of experience in healthcare claims analysis
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS)
• 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 and reimbursement methodologies
• Expert level knowledge of Microsoft Office suite
• Experience with Tableau, Amazon WorkSpaces, Jira, and Confluence

Preferred Qualifications

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

Benefits

• Medical, dental, and vision plan options
• 401(k) plan with company match
• Paid time off including vacation, sick, and personal time
• Paid parental, military, bereavement, and jury duty leave
• Short and long-term disability and life insurance

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.