Job Description

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 of U.S. citizens.

Job Description

At GDIT, people are our differentiator. As an Investigative Analyst supporting the Centers for Medicare and Medicaid (CMS), you will be trusted to identify trends in the data and create leads and referrals for the Healthcare Fraud Prevention Partnership (HFPP) members (Partner) and the Trusted Third Party (TTP).

You will be part of a 50-person team supporting the TTP which was established in 2012 to reduce fraud, waste and abuse in healthcare data.

We are GDIT. The people supporting and securing some of the most complex government, defense, and intelligence projects across the country. We ensure today is safe and tomorrow is smarter. Our work has meaning and impact on the world around us, but also on us, and that’s important.

GDIT is your place. You make it your own by embracing autonomy, seizing opportunity, and being trusted to deliver your best every day.

We think. We act. We deliver. There is no challenge we can’t turn into opportunity. Our work depends on a Partner Liaison joining our team to support CMS Trusted Third Party activities.

HOW AN INVESTIGATIVE ANALYST WILL MAKE AN IMPACT:

• Performs analytical tasks in support of HFPP program, including identifying fraud, waste, and abuse referrals and leads from HFPP Analytics
• Conduct data mining across the partnership utilizing internal tools
• Collaborate on the development of HFPP analytic reports
• Develops fraud, waste, and abuse referrals and leads for Partners based on HFPP analytic reports
• Drive outcome metrics related to fraud, waste, and abuse referrals and leads shared with Partners
• Interacts regularly with Partners regarding referrals and leads identified
• May perform business development activities including analyzing health claims data, generating study referrals and leads, developing provider background profiles, and identifying opportunities for Partner collaboration meetings

WHAT YOU'LL NEED TO SUCCEED:

• BA/BS or equivalent experience
• 5+ years’ experience in health care claims analysis
• Strong oral and written communication skills with the 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.

SECURITY CLEARANCE LEVEL:

• Must be able to obtain a public trust clearance

DESIRED QUALIFICATIONS AND EXPERIENCE:

• Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) designation strongly desired.
• Certified clinical coding

SOFT SKILLS QUALIFICATIONS:

• Strong decision-making skills and a demonstrated history of established leadership qualities as well as proven organizational skills. 
• Commitment to confidentiality, privacy, and professionalism.
• Ability to independently follow through on problems. 
• Detail oriented and ability to prioritize multiple tasks and work under pressure. 
• Ability to work on complex projects with general direction and minimal guidance 
• Ability to build effective relationships, demonstrating strong interpersonal skills.
• Exhibit high initiative to get things accomplished; high organizational ability to juggle multiple priorities.
• Ability to perform well and achieve goals both in a team environment, with staff at all levels, and independently. 

Work Requirements

Years of Experience

5 + years of related experience

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

Certification

Certified Fraud Examiner (CFE) | Association of Certified Fraud Examiners (ACFE) - Association of Certified Fraud Examiners (ACFE)

Travel Required

10-25%

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