Req ID: RQ185457Type of Requisition: RegularClearance Level Must Be Able to Obtain: NonePublic Trust/Other Required: NACI (T1)Job Family: Functional ExpertsSkills:Analytical Thinking,Data Analysis,Medicare Claims,Medicare Policy,Medicare RegulationsExperience:8 + years of related experienceJob 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) data
Advanced, hands-on experience with Excel and PowerPoint
Analytical, detail-oriented, ability to solve complex problems, strong presentation skills
PREFERRED SKILLS:
Certified Professional Coder, Medicare Administrative Contractor (MAC) or Private Payer edits experience
Medicaid and Managed Care policy and data experience
LOCATION: RemoteCLEARANCE: 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 home
401K with company match
Comprehensive health and wellness packages
Internal mobility team dedicated to helping you own your career
Professional growth opportunities including paid education and certifications
Cutting-edge technology you can learn from
Rest and recharge with paid vacation and holidays
The likely salary range for this position is $102,000 - $138,000. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year. Paid leave and paid holidays are prorated based on the employee’s date of hire. The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most.We are GDIT. A global technology and professional services company that delivers consulting, technology and mission services to every major agency across the U.S. government, defense and intelligence community. Our 30,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 30 countries worldwide, offering leading capabilities in digital modernization, AI/ML, Cloud, Cyber and application development. Together with our clients, we strive to create a safer, smarter world by harnessing the power of deep expertise and advanced technology.We connect people with the most impactful client missions, creating an unparalleled work experience that allows them to see their impact every day. We create opportunities for our people to lead and learn simultaneously. From securing our nation’s most sensitive systems, to enabling digital transformation and cloud adoption, our people are the ones who make change real.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.
Full-time