Fraud Prevention System Edit Manager

Clearance Level
None
Category
Business Process Analysis
Locations
Baltimore, Maryland
Maryland

REQ#: RQ65765

Travel Required: Less than 10%
Requisition Type: Regular

At GDIT, people are our differentiator. Our work depends on an Edit Manager joining our team to support Medicare Program Integrity activities at CMS. As an Edit Manager supporting CMS Program Integrity initiatives, you will be trusted to identify, implement and maintain new system edits to prevent improper payments from the Medicare Trust Fund. You will be part of a 50-person team supporting this important CMS program integrity mission.

This GDIT position supports the Program Integrity Modelling and Analytic Services (PIMAS) contract with CMS. PIMAS conducts analysis, data modeling, data mining, and coding to identify and implement models & edits in the CMS Fraud Prevention System (FPS). The Edit Manager will be responsible for the edit work on this contract including regularly interfacing with CMS staff to discuss edit topics, resolve issues and respond to inquiries with tight turn-around deadlines.

A typical day as the Edit Manager includes regular interactions with staff and other leaders on the FPS program, both within GDIT and with other entities working on FPS including business partners (e.g., system maintainer) and CMS. In addition, the manager will write and review edit proposals, specifications and other technical documents for submission. Receive and reply to CMS urgent requests for information related to edits and other ad hoc program integrity requests. Work with subject matter experts to determine the viability of edit recommendations.

PRIMARY RESPONSIBILITIES

The FPS edit manager will be responsible for the identification, creation, implementation and maintenance of FPS edits. They will coordinate with internal and external FPS team members to ensure timely and accurate submission for all edit deliverables and effectively communicate

  • The manager will identify new candidate topics for possible FPS edits and evaluate them by using data to identify risk, document the CMS policy (LCD & NCD) that supports the edit and work with CMS and other entities to vet it against various system requirements.
  • The manager will also ensure that all approved edits are implemented correctly and timely into the FPS following the agreed upon system release schedule.
  • Once released, the incumbent will ensure the edit is functioning properly using ongoing QA/QC procedures and will respond timely to inquiries regarding the performance of edits in production.

CORE RESPONSIBLITIES

  • Meet all contract requirements for edit deliverables, timeliness and quality
  • Ensure quality in all edit processes, deliverables, and work product
  • Professionally and effectively communicate with staff at all levels
  • Manage & direct a staff of analysts and programmers.

REQUIRED QUALIFICATIONS

  • Bachelor's degree or equivalent experience
  • 5+ years of experience in Medicare Program Integrity work at a MAC, UPIC or other program integrity contractor.
  • 3+ years of experience working with Medicare Fee-for-Service pre-payment edits either in FPS, FISS, MCS, and/or VMS
  • Technical understanding of Medicare claims payment systems and processes
  • 3+ year experience managing or supervising others
  • Ability to pass CMS security clearance & background check

DESIRED QUALIFICATIONS

  • 3 years of experience in a technical environment supporting ongoing system releases
  • 3 years of experience interacting with CMS staff and management
  • Medical coding certification (s)
  • RN
  • Experience with Medicare Part C/D

WHAT GDIT CAN OFFER YOU

  • Ability to work remotely from anywhere in the US
  • Direct & regular interaction with CMS
  • Be on the front line of stopping fraud, waste and abuse in Medicare
  • Opportunity to work independently but also be part of a passionate team committed to protecting the Medicare Trust Fund
  • Excellent salary and benefits package

GDIT CAREERS

Opportunity Owned

Discover more at www.gdit.com/careers  

General Dynamics Information Technology is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status, or any other protected class.

We are GDIT. The people supporting some of the most complex government, defense, and intelligence projects across the country. We deliver. Bringing the expertise needed to understand and advance critical missions. We transform. Shifting the ways clients invest in, integrate, and innovate technology solutions. We ensure today is safe and tomorrow is smarter. We are there. On the ground, beside our clients, in the lab, and everywhere in between. Offering the technology transformations, strategy, and mission services needed to get the job done.

GDIT is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status, or any other protected class.