REQ#: RQ185457Public Trust: NACI (T1) Requisition Type: Regular Your Impact

Own your opportunity to work alongside federal civilian agencies. Make an impact by providing services that help the government ensure the well being of U.S. citizens.

Job Description

Seize your opportunity to make a personal impact as a Healthcare Policy Analyst Advisor supporting the Program Integrity Modeling and Analytic Support Contract (PIMASC) with the Centers for Medicare and Medicaid Services (CMS). PIMASC conducts analysis, data modeling, data mining, and coding to identify and implement edits and models in the CMS Fraud Prevention System (FPS). The Healthcare Policy Analyst Advisor will be responsible for supporting both edit and model initiatives by identifying risks/vulnerabilities, proposing solutions and assessing performance of existing/proposed solutions. The Healthcare Policy Analyst Advisor will be responsible for the identification, creation, implementation and maintenance of FPS edits. They will coordinate and effectively communicate with internal and external FPS team members to ensure timely and accurate submission of all edit deliverables. GDIT is your place to make meaningful contributions to challenging projects and grow a rewarding career.

At GDIT, people are our differentiator. As a Healthcare Policy Analyst Advisor you will help ensure today is safe and tomorrow is smarter. Our work depends on a Healthcare Policy Analyst Advisor joining our team as a trusted partner to work with specific technology and data science tools to detect and prevent fraud, waste, and abuse (FWA) across the Medicare and Medicaid programs.

HOW A HEALTHCARE POLICY ANALYST ADVISOR WILL MAKE AN IMPACT

Analyzes user needs and performs research and functional analysis on a variety of PIMASC projects.Interacts with staff and leaders in the PIMASC program, both within GDIT and externally, including business partners (e.g., system maintainer) and CMS. Conducts extensive policy research and reviews data analytics reports/dashboards to identify new candidates for FPS editing.Translates vulnerabilities to design edit methodology and parameters for data analysis and creation of edit algorithms.Independently produces edit proposals and other customer deliverables generated throughout the edit lifecycle.Performs edit monitoring and maintenance activities, including verification of appropriate edit execution.Manages CMS urgent requests for information related to edits and other ad hoc program integrity requests.Receives and replies to requests for clinical, policy and medical coding support for Medicare, Medicaid, and Managed Care models and studies.

WHAT YOU’LL NEED TO SUCCEED:

Education: Bachelor's degree and 8+ years of Medicare Fraud, Waste, and Abuse experience (or)10+ years of Medicare Fraud, Waste, and Abuse experience (in lieu of degree)Advanced knowledge of Integrated Data Repository (IDR) dataAdvanced, hands-on experience with Excel and PowerPointAnalytical, detail-oriented, ability to solve complex problems, strong presentation skills

PREFERRED SKILLS:

Certified Professional Coder, Medicare Administrative Contractor (MAC) or Private Payer edits experienceMedicaid and Managed Care policy and data experience

LOCATION: Remote

CLEARANCE: Ability to pass CMS background check and meet the residency requirement for having resided in the US for at least three (3) of the past five (5) years in order to obtain a Public Trust.

GDIT IS YOUR PLACE:

Full-flex work week to own your priorities at work and at home401K with company matchComprehensive health and wellness packagesInternal mobility team dedicated to helping you own your careerProfessional growth opportunities including paid education and certificationsCutting-edge technology you can learn fromRest and recharge with paid vacation and holidays