SRA International, Inc., A CSRA Company eMedNY Program Integrity Data Analyst in Menands, New York
Clearance Level Must Currently Possess:
No Active Clearance Required
Clearance Level Must Be Able to Obtain:
No Active Clearance Required
No Suitability Required
General Dynamics Information Technology and CSRA have united to create the premier provider of high-tech IT solutions to the government IT market. Together as General Dynamics Information Technology, we deliver cost-effective, next-generation IT solutions and services to the Department of Defense, the intelligence community and federal civilian agencies as they modernize their information systems.
CSRA serves as fiscal agent to the New York State Department of Health in the operations and enhancement of the statewide Medicaid Management Information Systems (known as eMedNY). The eMedNY scope of work includes claim receipt, data conversion, imaging, claims processing and payment, data center operations, provider telephone inquiry support, HIPAA Compliance, systems development, and quality assurance.
The Fraud/Data Analyst will explore new techniques to identify patterns of fraud, waste and abuse and other forms of improper payments. This will include a review of the current fraud control procedures and develop ways to identify and measure the impact of fraud. The Fraud/Data Analyst will analyze Medicaid claims and medical records to determine suspicious patterns of billing and illegal activity. She/He will review claims utilizing records and system reports to determine proper documentation, utilization and appropriateness of services to identify possible fraud and abuse. Further, the Fraud/Data Analyst will work as part of a team to detect fraud, report fraud alert schemes, including providers and support investigation of Medicaid fraud cases. She/He will stay current with fraud trends and analytical procedures. The Medicaid Fraud Analyst will act in concert with the state Fraud Control Units including the Office of Health Insurance Programs, the Office of the Medicaid Inspector General, and where appropriate the Medicaid Fraud Control Unit within the Office of the Attorney General, and state and local authorities.
Required experience criteria:
BA or equivalent + 6 yrs related experience, or MA + 4 yrs related experience
Medicaid programs and policies, auditing procedures and claims processing systems
Medical claims sampling and data collection procedures
Reviewing Medicaid provider information and enrollment applications
Generating reports detailing fraud detection and prevention activities
Reviewing medical claims to determine proper and improper billing
Knowledge of correct coding of medical procedures
Demonstrate expertise in reviewing claims and making appropriate decisions to detect fraud
Knowledge of medical terminologies like International Classification of Diseases (ICD) Version 10
Bachelor’s degree in accounting, healthcare administration, healthcare management, management information systems or related field
Microsoft Excel and Word
Six (6) years’ experience in Medical Claims processing / auditing
Preferred experience criteria:
Certification as Computer Information Systems Auditor
Membership in a National association associated with combating healthcare fraud and abuse, such as the Systems Audit and Control Association, National Association of Medicaid Fraud Control Units, or National Healthcare Anti-Fraud Association
Experience working with data in State Medicaid Data Warehouses
Knowledge of coding medical claims from multiple healthcare delivery organizations and/or insurance carriers
Working knowledge of Analytic tools such as Bi Query or Oracle Reports
Experience in healthcare fraud investigation/detection
Ability to identify opportunities to improve processes and procedures
# of Openings:
Scheduled Weekly Hours:
T elecommuting Options:
Telecommuting Not Allowed
USA NY Menands - 150 Broadway (NYS003)
Additional Work Locations:
CSRA is committed to creating a diverse environment and is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
THINK NEXT. NOW.
CSRA is tomorrow’s thinking, today. To “Think Next. Now.” is to imagine a better future and to deliver it, today. For our customers, our partners, and ultimately, all the people our mission touches, CSRA is realizing the promise of technology to change the world through next-generation thinking and meaningful results.
We understand that our customers' missions require new methods and imaginative thinking. We bring together government IT professionals, emerging technologies, and the brightest, cutting-edge advisors in the industry to deliver a broad range of innovative, next-generation IT solutions and professional services to help our customers modernize their legacy systems, protect their networks and assets, and improve the effectiveness and efficiency of mission-critical functions for our warfighters and our citizens.
Everywhere you look, CSRA is there. We’re in our nation’s infrastructure, in training and education, in cyber security, in serving veterans who served us—and, so much more. Take some time to learn more about CSRA. You might be surprised to learn how we touch your life.
We are a company of 18,000+ smart, talented individuals, yet we enjoy a start-up culture that inspires us to make a difference while delivering results in this rapidly evolving world. Join our team and use your skills and expertise to support the safety, security, health and well-being of the nation.