Healthcare Coding Expert (certified professional coder)

GDIT's Federal Health Division is hiring a Healthcare Coding Expert to support the Centers for Medicare and Medicaid (CMS). You will identify trends in data and create leads and referrals for the Healthcare Fraud Prevention Partnership (HFPP) members and the Trusted Third Party (TTP), a 50-person team established in 2012 to reduce fraud, waste, and abuse in healthcare data. Work is expected to begin in October 2026.

About the role

• Performs analytical tasks in support of the HFPP program, including identifying fraud, waste, and abuse referrals and leads from HFPP Analytics
• Collaborates on the development of HFPP analytic reports
• Drives 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
• Identifies fraud, waste, and abuse schemes and conducts 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 analytic output questions from internal and external parties
• May coach and provide guidance to less experienced professionals

Requirements

• Bachelor’s degree or equivalent years of work experience
• 8+ years of experience in healthcare claims analysis
• Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC) or Certified Coding Specialist (CCS) through the American Health Information Management Association (AHIMA)
• Expertise in medical terminology and all healthcare coding (e.g., ICD-10, CPT, 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 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

Preferred Qualifications

• Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) designation

Skills

• Strong decision-making and leadership qualities
• Proven organizational skills and ability to prioritize multiple tasks under pressure
• Commitment to confidentiality, privacy, and professionalism
• Ability to work independently with minimal guidance on complex projects
• Strong interpersonal skills and ability to build effective relationships
• High initiative and ability to achieve goals in both team and independent environments

Pay

The likely salary range for this position is $77,775 - $105,225.

Schedule

• Scheduled weekly hours: 40
• Travel required: 10-25%
• Telecommuting options: Remote

Benefits

• Medical, dental, and vision plan options, some with Health Savings Accounts
• 401(k) plan with pre- and post-tax contribution options and company match
• Paid time off: 15 days of vacation, sick, and personal time per calendar year (prorated based on hire date), plus 10 paid holidays
• GDIT Paid Family Leave program: up to 160 hours of paid leave in a rolling 12-month period for eligible employees
• Short- and long-term disability benefits, life insurance, accidental death and dismemberment, personal accident, critical illness, and business travel and accident insurance