Job Summary
An aerospace and defense company is seeking a Remote Clinical Fraud Analyst in Pittsburgh.
Core Responsibilities of this position include:
- Identifying and documenting gaps or risks in current CMS policy
- Ensuring quality in all edit processes, deliverables, and work product
- Meeting all contract requirements for edit deliverables, timeliness and quality
Position Requirements Include:
- Less than 10% travel
- Technical understanding of Medicare policy, processes and claims payment systems
- 2+ years of experience in clinical coding with the corresponding appropriate professional certification(s)
- 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
- Ability to pass CMS security clearance & background check
