Job Description

Location:
Washington,DC,US
Remote Work:
Hybrid
Job Number:
R0189401
Healthcare Fraud and Analytics Subject Matter Expert

Key Role:

Grow with our compliance and anti-fraud team with the responsibility to perform advanced analyses and studies to ensure the integrity of the client's programs. Review provider and contractor audit reports and policy analyses to assist in identifying and monitoring program vulnerabilities and evaluating the impact of initiatives aimed at preventing or recovering improper payments. Assist with developing and implementing the program integrity focused engagement and growth strategy. Leverage client-specific knowledge and networks to lead, plan, grow, and manage progressively larger and more complex programs. Generate innovative ideas for creative solutions and collaborate with other subject matter experts to ensure specialized topics are appropriately addressed. Conduct active surveillance of notable or emerging trends in CMS Program payment structures. Assist the client in efforts to identify and assess exposure or vulnerability to fraud, waste, and abuse in client programs and provide support and assistance to state program integrity functions. Assess and monitor the impact of policy and payment changes on access to care, beneficiary health outcomes, and client program payments, while applying healthcare payer expertise to address payer strategic and operational priorities.

Basic Qualifications:

  • 5+ years of experience in healthcare fraud, analytics, medical coding, and the operations of special investigative units (SIU)
  • Experience with program integrity tactics, procedures, processes, and programs
  • Experience with healthcare payer audits, investigations, and reviews, including data analysis, interviewing, report writing and editing, and case presentation or briefing
  • Knowledge of program integrity related policies, plans, and procedures
  • Knowledge of both federal and state payer data, including encounter data, claims, and administrative data
  • Bachelor's degree in Healthcare, Science, Public Health, Policy, or Administration
  • Accredited Healthcare Fraud Investigator (AHFI) Certification
  • Health Care Anti-Fraud Associate (HCAFA) Certification
  • Certified Insurance Fraud Investigator (CIFI) Certification
  • Certified Financial Crimes Investigator (CFCI) Certification

Additional Qualifications:

  • Experience in the evaluation, assessment, analysis, or administration of CMS Program policy, including Medicare, Medicaid, CHIP, or Marketplace
  • Experience working with the Centers for Medicare and Medicaid Services (CMS) - Center for Program Integrity
  • Experience with delivering sensitive information and technical content to a wide range of stakeholders and using a variety of delivery techniques
  • Experience in facilitating large meetings with both internal and external audiences
  • Knowledge of the federal procurement and proposal process, and contract management principles
  • 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)
  • Certified Fraud Examiner (CFE) Certification
  • Certified in Healthcare Compliance (CHC) Certification
  • Medical auditing or clinical coding Certification, including CPC, CEMA, or CPMA

Create Your Career: 


Grow With Us 
Your growth matters to us—that’s why we offer a variety of ways for you to develop your career. With professional and leadership development opportunities like upskilling programs, tuition reimbursement, mentoring, and firm-sponsored networking, you can chart a unique and fulfilling career path on your own terms. 

A Place Where You Belong 
Diverse perspectives cultivate collective ingenuity. Booz Allen’s culture of respect, equity, and opportunity means that, here, you are free to bring your whole self to work. With an array of business resource groups and other opportunities for connection, you’ll build your community in no time. 

Support Your Well-Being 
Our comprehensive benefits package includes wellness programs with HSA contributions, paid holidays, paid parental leave, a generous 401(k) match, and more. With these benefits, plus the option for flexible schedules and remote and hybrid locations, we’ll support you as you pursue a balanced, fulfilling life—at work and at home. 

Your Candidate Journey 
At Booz Allen, we know our people are what propel us forward, and we value relationships most of all. Here, we’ve compiled a list of resources so you’ll know what to expect as we forge a connection with you during your journey as a candidate with us.

Compensation

At Booz Allen, we celebrate your contributions, provide you with opportunities and choices, and support your total well-being. Our offerings include health, life, disability, financial, and retirement benefits, as well as paid leave, professional development, tuition assistance, work-life programs, and dependent care. Our recognition awards program acknowledges employees for exceptional performance and superior demonstration of our values. Full-time and part-time employees working at least 20 hours a week on a regular basis are eligible to participate in Booz Allen’s benefit programs. Individuals that do not meet the threshold are only eligible for select offerings, not inclusive of health benefits. We encourage you to learn more about our total benefits by visiting the Resource page on our Careers site and reviewing Our Employee Benefits page.

Salary at Booz Allen is determined by various factors, including but not limited to location, the individual’s particular combination of education, knowledge, skills, competencies, and experience, as well as contract-specific affordability and organizational requirements. The projected compensation range for this position is $73,100.00 to $166,000.00 (annualized USD). The estimate displayed represents the typical salary range for this position and is just one component of Booz Allen’s total compensation package for employees. This posting will close within 90 days from the Posting Date.

Work Model
Our people-first culture prioritizes the benefits of flexibility and collaboration, whether that happens in person or remotely.

  • If this position is listed as remote or hybrid, you’ll periodically work from a Booz Allen or client site facility.
  • If this position is listed as onsite, you’ll work with colleagues and clients in person, as needed for the specific role.

EEO Commitment

We’re an equal employment opportunity/affirmative action employer that empowers our people to fearlessly drive change – no matter their race, color, ethnicity, religion, sex (including pregnancy, childbirth, lactation, or related medical conditions), national origin, ancestry, age, marital status, sexual orientation, gender identity and expression, disability, veteran status, military or uniformed service member status, genetic information, or any other status protected by applicable federal, state, local, or international law.

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