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.
