Healthcare Coding Expert (certified professional coder)

Type of Requisition: Regular Clearance Level Must Currently Possess: None Clearance Level Must Be Able to Obtain: None Public Trust/Other Required: None Job Family: Ancillary Health Job Qualifications: Skills: Claims Data, Data Analysis, Microsoft Excel, Policy Analysis, Strategic Objectives Certifications: None Experience: 8 + years of related experience US Citizenship Required: No Job Description: GDIT's Federal Health Division is hiring a Healthcare Coding Expert to support 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. Work expected to begin in October 2026 Work visa sponsorship will not be considered for this position WHAT YOU'LL BE DOING: Performs analytical tasks in support of HFPP program, including identifying fraud, waste, and abuse referrals and leads from HFPP Analytics Collaborate on the development of HFPP analytic reports Drive outcome metrics related to fraud, waste, and abuse referrals and leads shared with Partners 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 Reviews and analyzes medical claims to determine accuracy, completeness and compliance with insurance policies, coding guidelines and reimbursement criteria. Identify fraud, waste, and abuse schemes and conduct research and investigation of insurance policies, coding guidelines and reimbursement criteria Participates in quality assurance initiatives to ensure deliverable adherence to regulatory requirements, medical and company policies and industry standards. Evaluates and responds to analyti