CMS Fraud Waste and Abuse Analyst

Clearance Level
Functional Experts
Baltimore, Maryland

REQ#: RQ97157

Travel Required: Less than 10%
Requisition Type: Pipeline
GDIT is searching for individuals to support the Center for Medicare & Medicaid Services’ (CMS) mission to detect and combat fraud, waste, and abuse of the Medicare and Medicaid programs. GDIT works with CPI to ensure CMS is paying the right provider the right amount for services covered. Our work focuses on protecting patients while also minimizing unnecessary burden on providers. Through research, investigation and data analysis, the desired outcomes of our efforts are to prevent, detect, and resolve noncompliance with Medicare rules, requirements, and law and recommend administrative action to CMS.Responsibilities
  • Conduct research, data analysis, and investigative activities to assess compliance with Medicare and Medicaid regulatory requirements.
  • Work collaboratively within a team of Medicare and Medicaid policy expert SMEs and data analysts.
  • Strictly follow CMS-approved SOPs as to how to conduct fraud, waste and abuse (FWA) lead reviews and investigations and have input into recommendations for SOP updates as needed.
  • Within a case management system, comprehensively document in detail all lead and investigation activity and recommendations to CMS.
  • Actively support preparation of comprehensive reports on the status of leads and investigations required by CMS.
  • Safeguard PII and PHI
  • Infrequent travel may be required
  • Bachelor’s degree or equivalency in regulatory or investigative field and 2+ years of Medicare-Medicaid experience
  • Highly organized, ability to multi-task and meet deadlines
  • Proficient in computer skills, e.g. Microsoft Office-Word, Excel
  • Strong inter-personal and communications skills, both written and oral
  • Ability to conceptualize, solve problems and draw conclusions
Value-Add Experience
  • Experience with FWA claims and investigations
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.