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Healthcare Fraud And Analytics Subject Matter Expert
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$73,100 - $166,000 a year
Full-time
- 5+ years of experience in healthcare fraud, analytics, medical coding, and the operations of special investigative units (SIU)
- Experience in the evaluation, assessment, analysis, or administration of CMS Program policy, including Medicare, Medicaid, CHIP, or Marketplace
- Knowledge of CMS claims data, including Medicare, Medicaid, and Marketplace, in the IDR or CCW environment with Fee-for-Service (FFS), Medicare Advantage encounter data, Medicaid data in the Transformed Medicaid Statistical Information System (T-MSIS), or Prescription Drug Event (PDE) data
- Knowledge of CMS program integrity related systems and resources, including One PI, Provider Enrollment, Chain, and Ownership System (PECOS), Fraud Prevention System (FPS), Unified Case Management (UCM), or National Plan and Provider Enumeration System (NPPES)
- Bachelor's degree in Healthcare, Science, Public Health, Policy, or Administration
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