Healthcare Coding Expert, Certified Professional Coder

🔥 5 minutes ago

🇺🇸 United States – Remote

💵 $77.8k - $105.2k / year

⏰ Full Time

🟠 Senior

🔴 Lead

🏥 Medical Billing and Coding

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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General Dynamics Information Technology

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1954

💼 Consulting

🏥 Healthcare

📦 Logistics

Consulting • Healthcare • Logistics

General Dynamics Information Technology is a company at the forefront of technological innovation, offering a wide range of services including consulting, digital modernization, and application services. The company is heavily involved in implementing solutions related to artificial intelligence, cloud computing, cybersecurity, high-performance computing, and quantum technologies. GDIT is committed to supporting government and defense sectors, providing mission-critical services such as logistics and supply chain management, intelligence, and homeland security. The company also focuses on diverse and inclusive hiring practices and actively promotes employee well-being. Through its digital accelerator solutions and pioneering use of emerging technologies, GDIT aims to propel agencies' missions forward and address complex technological challenges.

📋 Description

• Perform analytical tasks supporting the HFPP program • Identify fraud, waste, and abuse referrals and leads from HFPP Analytics • Collaborate on development of HFPP analytic reports • Drive outcome metrics related to referrals and leads shared with Partners • Analyze health claims data • Generate study referrals and leads • Develop provider background profiles • Identify opportunities for Partner collaboration meetings • Review and analyze medical claims for accuracy, completeness, and compliance with insurance policies, coding guidelines, and reimbursement criteria • Identify fraud, waste, and abuse schemes • Research and investigate insurance policies, coding guidelines, and reimbursement criteria • Participate in quality assurance initiatives to ensure deliverables meet regulatory requirements, medical and company policies, and industry standards • Evaluate and respond to analytic output questions from internal and external parties • Coach and provide guidance to less experienced professionals

🎯 Requirements

• Bachelor's degree or equivalent year of work experience • 8+ years of experience in healthcare claims analysis • Certified Professional Coder (CPC) through AAPC or Certified Coding Specialist (CCS) through AHIMA • Expertise in medical terminology and healthcare coding, including ICD-10, CPT, and HCPCS • Experience in program integrity and healthcare fraud, waste, and abuse activities, including edits, audits, pre-payment and post-payment review, investigations, and referrals • Extensive knowledge of insurance regulations, reimbursement methodologies, and healthcare compliance requirements • Strong oral and written communication skills with ability to present to management-level staff • Expert-level knowledge of Microsoft Office suite • Experience with Tableau, Amazon WorkSpaces, Jira, and Confluence • Working knowledge of HIPAA privacy and security rules • Ability to work independently and with minimal guidance • Ability to prioritize multiple tasks and work under pressure • Ability to work effectively in team and independent environments • CFE or AHFI designation strongly desired

🏖️ Benefits

• Medical plan options, including some with Health Savings Accounts • Dental plan options • Vision plan • 401(k) plan with pre-tax and post-tax contributions and company match • Flexible work weeks where possible • Vacation, sick, personal, holiday, parental, military, bereavement, and jury duty leave • Typically 15 days of paid leave per calendar year • 10 paid holidays per year • Up to 160 hours of paid family leave in a rolling 12-month period for eligible employees • Short- and long-term disability benefits • Life insurance • Accidental death and dismemberment insurance • Personal accident insurance • Critical illness insurance • Business travel and accident insurance • Remote work