Job Abstract

Key Role:

Grow with our compliance and anti-fraud team with the responsibility to perform advanced analyses to ensure the integrity of health insurance programs. 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. Assist the client in efforts to identify and assess exposure or vulnerability to fraud, waste, and abuse in 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 program payments, while applying healthcare payer expertise to address payer strategic and operational priorities. Due to the nature of work performed within this facility, U.S. citizenship is required.

Basic Qualifications:

• Experience analyzing, interpreting, and writing reports of data findings to identify vulnerabilities for fraud, waste, and abuse in Medicare and Medicaid programs

• Experience with healthcare payer audits, investigations, and reviews, including data analysis, interviewing, report writing and editing, and case presentation or briefing

• Knowledge of Medicare Parts A, B, C, and D benefits, including pharmacy drug data

• Knowledge of Centers for Medicare and Medicaid Services (CMS) National Coverage Determinations and MAC Local Coverage Determinations

• Knowledge of Medicare and Medicaid programs, particularly the coverage and payment rules, as well as models, edits, and various analytic projects

• 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 program integrity policies, plans, and procedures such as the Medicare Program Integrity manual, the Comprehensive Medicaid Integrity Plan, Provider Screening and Enrollment requirements, or the Medicaid Provider Enrollment Compendium (MPEC)

• Ability to 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

• Bachelor’s degree in Healthcare, Science, Public Health, Policy, or Administration

Additional Qualifications:

• Experience delivering sensitive information and technical content to a wide range of stakeholders, and using a variety of delivery techniques

• Experience working with the CMS and Center for Program Integrity

• Knowledge of CMS program integrity related systems and resources, such as One PI, the Provider Enrollment, Chain, and Ownership System (PECOS), the Fraud Prevention System (FPS), Unified Case Management (UCM), and the National Plan and Provider Enumeration System (NPPES)

• Knowledge of the federal procurement and proposal process, and project management principles

• Ability to apply automation techniques to drive insights and efficiency

• Ability to work collaboratively and build effective working relationships

• Accredited Healthcare Fraud Investigator (AHFI), Health Care Anti-Fraud Associate (HCAFA), Certified Insurance Fraud Investigator (CIFI), Certified Financial Crimes Investigator (CFCI), Certified Fraud Examiner (CFE), or Certified in Healthcare Compliance (CHC) Certifications

• Medical Auditing or Clinical Coding Certifications, such as CPC, CEMA, or CPMA

• Project Management Professional (PMP) Certification

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.

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.