Nurse Analyst/Investigator [Remote]

Public Trust: None

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 and support of U.S. citizens.

Job Description

We are GDIT. As one of the largest IT and mission services providers to the government, we own our opportunities to better enable healthcare organizations to identify theirs.

You can make GDIT your place. You make it your own by turning obstacles into action. By owning your opportunity at GDIT, you’ll play an important role in providing the technologies and services that millions of healthcare professionals depend on, every day. Our work depends on a Nurse Analyst / Investigator joining our team to support Centers for Medicare & Medicaid Services (CMS) activities at Baltimore, Maryland.

GDIT is under contract to the Centers for Medicare & Medicaid Services (CMS) to design, develop, engineer, implement, enhance, maintain statistical algorithms to detect and prevent potential fraud, waste or abuse in the Medicare and Medicaid programs. The contract is part of the Fraud Prevention System Modeling and Analytics contract. GDIT are responsible for post-payment (models) and pre-payment (edits) identification and implementation to support the CMS’ Center for Program Integrity (CPI).

At GDIT, we put our people first. As a Nurse Analyst/Investigator supporting CMS, you will be trusted to work on specific technology and data science tools to detect and prevent fraud, waste, and abuse (FWA) across the Medicare and Medicaid programs. In this role, a typical day will include:

• Interacting with staff and leaders in the FPS program, both within GDIT and with other entities working on FPS, including business partners (e.g., system maintainer) and CMS.
• Writing and reviewing edit proposals and consult with others regarding policy, medical coding, and clinical questions.
• Receiving and replying to CMS urgent requests for information related to edits and other ad hoc program integrity requests.
• Reviewing CMS policy and regulations to anchor support for new FPS edits and models.
• Identifying new candidate topics for possible FPS edits and evaluate them by using data to identify risk and document CMS policy (e.g., LCD, NCD) that supports the edit.

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Required Skills:

• RN or LPN with 5+ years clinical experience
• 2+ years of experience in Medicare Program Integrity work at a MAC, UPIC or other program integrity contractor
• 2+ years of experience in medical coding with the corresponding appropriate professional certification(s) (e.g., CPC) or ability to attain certification within 12 months
• Working knowledge of Medicare policy, processes and claims payment systems
• Ability to pass CMS security clearance & background check

Desired Skills:

• 3 years of experience interacting with and consulting with others with a different background/expertise in a team environment
• BA/BS/BSN
• CPC certification
• 2+ years of experience working with Medicare Fee-for-Service pre-payment edits either in FPS, FISS, MCS, and/or VMS
• Experience with Medicaid, Medicare Part C/D

Work Requirements

Years of Experience

10 + years of related experience

* may vary based on technical training, certification(s), or degree

Certification

Travel Required

Less than 10%