Fraud Waste & Abuse Subject Matter Expert

Clearance Level
None
Category
Data Analysis
Location
Not Applicable, Maryland

REQ#: RQ70330

Travel Required: Less than 10%
Requisition Type: Regular

At GDIT, people are our differentiator, and our work to support clients depends on finding talented and knowledgeable team members.  As part of our efforts to support the Centers for Medicare and Medicaid Services (CMS), GDIT is seeking a Fraud, Waste and Abuse Subject Matter Expert (FWA SME) to join our team’s anti-fraud activities. The FWA SME will support GDIT’s Program Integrity Modeling & Analytic Services (PIMAS) contract by guiding fraud detection strategies, assessing their effectiveness, and communicating outcomes to internal and external partners. You will be a part of a talented team supporting PIMAS fraud, waste and abuse data analytics.

In this role, a typical day will include:

  • This position is within a multi-disciplinary team of Data Scientists, Business Intelligence Analysts and other FWA SMEs. Our team is 100% remote and distributed throughout the country.
  • This position will be responsible for supporting FWA study development and execution activities for multiple CMS programs (Medicare FFS, Part C, Part D, Medicaid).
  • This team member will have an in-depth understanding of and ability to educate various audiences about how claims data are reported, processed, and used to inform study results.
  • This position involves policy, program and industry research, and will synthesize research findings into a cogent, analytic rationale that can be articulated to end users.
  • This position involves the preparation and editing of written documents, spreadsheets, presentations and other artifacts important to communicating results of the meaningful work being completed.
  • This team member will be called upon to identify actionable findings within the analytic output; likewise, the position involves packaging and communicating those value propositions to the various customers including: government administrative agencies such as CMS and Medicaid programs, and especially Law Enforcement.

REQUIRED QUALIFICATIONS

  • Bachelor’s degree in relevant healthcare, investigations or related discipline
  • 15+ years of relevant experience in fraud detection, investigation and intervention, with a focus in traditional Medicare and other CMS payment programs (e.g., Part D, Medicaid).
  • 15+ years of relevant experience in healthcare fraud investigations, with demonstrable experience across the spectrum of fraud detection and in intervention activities, including ALL of the following:
    • Utilizing data analysis outputs to detect and define target areas;
    • Investigative activities including both desk audit and fieldwork;
    • Documentation and pursuit of administrative actions such as termination, suspension and overpayment recovery; and
    • Packaging cases for law enforcement in support of civil recovery and/or criminal prosecution.
  • 10+ years of experience utilizing medical claims coding systems (e.g., ICD-10, CPT, HCPCS, NDC)
  • Strong knowledge of health care benefit structure and claim processing systems
  • Experience researching and interpreting payer medical (coverage) policies (e.g., LCDs, NCDs, private carrier medical policies) and common industry claim edits (e.g., NCCI)

DESIRED QUALIFICATIONS

  • Ability to communicate technical and non-technical language to technical and non-technical audiences
  • Ability to prioritize multiple tasks to meet established deadlines and satisfy internal and external customer demands
  • Proficient in Microsoft products and visualization tools
  • Ability to compile and deliver polished public presentations when necessary
  • Knowledge of healthcare fraud intervention processes for Law Enforcement
  • Knowledge of Pharmacy billing, data and fraud issues

WHAT GDIT CAN OFFER YOU

  • Ability to work remotely from anywhere in the US
  • 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
  • Competitive pay and benefits, flexible work schedule, collaborative inter-disciplinary environment where the best idea wins.

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.