Health Compliance and Fraud Lead, Senior Manager

Key Role:

Lead and grow our compliance and fraud team with the responsibility to perform advanced analyses and studies of claims and administrative data to ensure the integrity of the Medicare, Medicaid, CHIP, and Marketplace Programs. Evaluate provider and contractor audits and policy reviews, identification, and monitoring of program vulnerabilities, and provide support and assistance to state integrity functions. Monitor and assess the impact of policy and payment changes on access to care, beneficiary health outcomes, and CMS Program payments. Conduct active surveillance of notable trends in CMS Program payment systems. Assist the client in its efforts to identify and assess exposure to fraud, waste, and abuse in CMS Programs. Evaluate the impact of initiatives aimed at preventing or recovering improper payments and conduct numerous and varied ad hoc data analyses. Leverage client-specific knowledge and network to lead, plan, and manage progressively larger and more complex programs.

Basic Qualifications:

• 10+ years of experience in a managerial role overseeing large projects, budgets, and numerous staff

• Experience in working with Centers for Medicare and Medicaid Services (CMS) Center for Program Integrity

• Experience with building a payer analytic team and building analytic solutions and products

• Knowledge of CMS claims data, including Medicare, Medicaid, and Marketplace, in either the IDR or CCW environment with Fee-for-Service (FFS), Medicare Advantage encounter data, or Prescription Drug Event (PDE) data

• Knowledge of both federal and state payer data, including encounter data, claims, and administrative data

• Experience with program integrity tactics

• Ability to obtain a security clearance

• Bachelor's degree

Additional Qualifications:

• Experience with delivering technical assistance to a wide range of stakeholders and using a variety of delivery techniques

• Experience in facilitating large meetings with both internal and external audiences

• Experience with the federal procurement and proposal process

• Knowledge of fraud, waste, and abuse and program integrity programs

• Ability to apply Artificial Intelligence (AI), Machine Learning (ML), and automation techniques to drive insights and efficiency

• Ability to demonstrate relationships in the CMS agency, including in the Center for Program Integrity (CPI)

Clearance:

Applicants selected will be subject to a security investigation and may need to meet eligibility requirements for access to classified information.

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 $118,000.00 to $220,000.00 (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.

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.