Nurse Analyst/Investigator
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Job Description
Nurse Analyst/Investigator supporting CMS activities at GDIT. Interacting with stakeholders in fraud prevention with a focus on Medicare and Medicaid systems.
Responsibilities:
- Support Centers for Medicare & Medicaid Services (CMS) activities at Baltimore, Maryland
- Interact with staff and leaders in the FPS program, both within GDIT and with other entities working on FPS
- Write and review edit proposals and consult with others regarding policy, medical coding, and clinical questions
- Receive and reply to CMS urgent requests for information related to edits and other ad hoc program integrity requests
- Review CMS policy and regulations to anchor support for new FPS edits and models
- Identify 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
Requirements:
- 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
- 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
Benefits:
- Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts
- Dental plan options
- Vision plan
- 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
- Full flex work weeks where possible
- A variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave
- 15 days of paid leave per calendar year
- 10 paid holidays per year
- Eligible employees can receive up to 160 hours of paid leave in a rolling 12 month period for family leave
- Short and long-term disability benefits
- Life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance
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