MITRE is seeking Project Leaders and Domain Specialists to support the Centers for Medicare and Medicaid (CMS), Center for Program Integrity (CPI) program. CPI’s mission is to protect the Medicare and Medicaid programs from fraud, waste, and abuse (FWA).
Responsibilities:
- Develops and executes cross-agency improper payment, fraud, and risk use cases.
Requirements:
- Working knowledge of and or experience with the HHS-Office of Inspector General (HHS-OIG) as well as CMS’ Center for Program Integrity and other related Centers within CMS
- Deep knowledge of the Medicare and Medicaid payer systems and payment models, as well as experience with their payment partners (MCOs)
- Experience with or leading Healthcare Fraud Investigative teams comprised of data analysts, medical reviewers, medical coders and FWA investigators.
- Understanding in Fraud, Waste and Abuse detection, investigation and medical review for Medicare, Medicaid, and Commercial health insurance programs.
- Experience with investigative specialties including pricing and fee schedules, ICD-9/ICD-10, HCPCS and CPT coding, medical terminology, medical and payment policy, Medicare compliance, auditing and quality control, overpayment recovery, HIPAA regulations, and healthcare regulatory requirements.
- Experience with industry-leading Medicare FWA, data analysis and case management tools.
- Minimum BS or BA degree in applicable healthcare, science or similar fields; MS degrees Preferred.
