Nurse Analyst / Investigator

About the role

GDIT is seeking a Nurse Analyst/Investigator to support the Centers for Medicare & Medicaid Services (CMS) in Baltimore, Maryland. The role focuses on using data‑driven tools to detect and prevent fraud, waste, and abuse within Medicare and Medicaid programs.

Key responsibilities

• Collaborate with CMS staff, internal GDIT teams, and external partners on the Fraud Prevention System (FPS) program.
• Write, review, and consult on edit proposals, addressing policy, medical coding, and clinical questions.
• Respond to urgent CMS requests for information and ad‑hoc program integrity inquiries.
• Analyze CMS policies and regulations to support new FPS edits and models.
• Identify and evaluate new candidate topics for FPS edits using data risk analysis and relevant CMS guidance.

Required profile

• Registered Nurse (RN) or Licensed Practical Nurse (LPN) with at least 5 years of clinical experience.
• Minimum 2 years of experience in Medicare Program Integrity work (e.g., MAC, UPIC, or similar contractor).
• At least 2 years of medical coding experience with ability to obtain a CPC certification within 12 months.
• Strong knowledge of Medicare policies, processes, and claims payment systems.
• Ability to pass CMS security clearance and background check.

Required skills

• Microsoft Excel
• Medical coding