Nurse Analyst, Investigator

This is a fully remote position, open to applicants in Maryland.

📋 Description

• Engaging with staff and leaders within the FPS program

• Composing and assessing edit proposals

• Providing consultation on policy, medical coding, and clinical inquiries

• Addressing urgent information requests from CMS

• Reviewing CMS policies and regulations pertaining to new FPS edits

• Identifying potential new topics for FPS edits

• Evaluating these topics by leveraging data to assess risk and document CMS policy

⛳️ Requirements

• RN or LPN with over 5 years of clinical experience

• A minimum of 2 years of experience in Medicare Program Integrity work at a MAC, UPIC, or other program integrity contractor

• At least 2 years of experience in medical coding with relevant professional certification(s) (e.g., CPC) or the capability to achieve certification within 12 months

• Proficient understanding of Medicare policy, processes, and claims payment systems

• Must be able to pass CMS security clearance and background check

• 3 years of experience in collaboration and consulting within a team environment

• BA/BS/BSN is preferred

• Experience with Medicare Fee-for-Service pre-payment edits in FPS, FISS, MCS, and/or VMS

🏝️ Benefits

• A range of medical plan choices that include Health Savings Accounts

• Options for dental plans

• Vision plan availability

• 401(k) plan featuring company match

• Flexible working weeks

• Paid time off covering vacation, sick, and personal days

• 10 paid holidays each year

• 15 days of paid leave per calendar year

• Paid Family Leave program

• Short-term and long-term disability benefits

• Life insurance coverage

• Accidental death and dismemberment insurance

• Personal accident and critical illness insurance

• Business travel and accident insurance