Post Payment Analytics (PPA) Subject Matter Expert (SME)

Trilogy Federal
vision insurance, parental leave, paid time off, paid holidays, tuition reimbursement, 401(k)
United States, D.C., Washington
810 Vermont Avenue Northwest (Show on map)
Mar 24, 2025
Trilogy Federal provides financial management, information technology (IT) consulting, program management services, and strategic consulting to federal agencies. Trilogy has an extensive history helping federal clients achieve their most ambitious business modernization and optimization goals with the ability to deliver targeted subject matter expertise and full life cycle support. Trilogy Federal is looking for a Post Payment Analytics (PPA) Subject Matter Expert (SME) to support a large program office within Veterans Health Administration. The selected candidate will have an important role on a high-performing team focused on supporting programs that provide Veterans and their Family Members exceptional health benefit services that improve their health and well-being through congressionally mandated programs. The person supporting this program should be motivated, driven, and client focused to join our highly collaborative and customer-oriented team. The goal for the SME position is to support the development and provision of a PPA framework including but not limited to providing business savvy sense and direction to a high performing data team on various health care procedure and/or drug codes and hon how to analyze and understand payment discrepancies, areas of fraud waste and abuse, and cost impact to the VA. Moreover, this SME will promote healthcare industry best practices grounded in progressive approaches to managing data and preventing post payment issues and anomalies. The person in this position likely has commercial healthcare experience managing payment data. This position may require occasional travel in support of client needs and expectations. Please note this position is contingent upon award (approximately April/May 2025) Primary Responsibilities: Support the development of highly complex family member program reports and deliverables and other supporting activities related to PPA dashboard administration and maintenance. Perform analysis on payment data that leads to improved revenue cycle efficiency. Perform data mining and query development activity to uncover improper payments that may come as a result of billing error, fraud, waste and abuse. Evaluate claim data to identify trends and optimize financial performance. Execute data collection, analysis, reporting, and collaboration with other stakeholders to address payment issues. Ad hoc and other strategic support tasks, as assigned by client and project manager. Minimum Requirements: Master's degree At least 10 years' experience implementing programs and supporting progressive analytics in a large organization (Federal agencies and/or private corporate firms) Extensive knowledge regarding industry standard billing practices, particularly Medicare Extensive knowledge understanding and assessing the use of CPT, HCPCS, ICD and other relevant billing codes, to include modifiers. Extensive knowledge of Medicare IPPS, OPPS and all associated policies and edits Knowledge of valued based care principles and concepts Knowledge of CAQH Core The ability to obtain a Public Trust Clearance. Excellent written and verbal communications skills The ability to support ad hoc travel, per customer requirements Successful engagement with organizational senior leadership Preferred Qualifications: VA or Federal experience. Prior experience working in a healthcare organization (e.g., hospital, health system, health insurance company, military health etc.). Benefits (including but not limited to): Health, dental, and vision plans Optional FSA Paid parental leave Safe Harbor 401(k) with employer contributions 100% vested from day 1 Paid time off and 11 paid holidays No cost group term life/AD&D plan, and optional supplemental coverage Pet insurance Monthly phone and internet stipend Tuition and training reimbursement This range is not a guarantee of compensation or salary, as Trilogy Federal conducts an individual equity review for every candidate based on experience, location, education, industry experience, and comparisons to internal pay bands. In addition to salary, Trilogy offers robust benefits including medical/dental/vision insurance coverage, 401(k) match, paid holidays, paid time off, tuition reimbursement, and a very supportive work/life balance. Regarding remote positions, Trilogy Federal is able to offer virtual employment in the following states: Colorado, Connecticut, D.C., Florida, Georgia, Illinois, Maryland, New York, South Carolina, Texas, and Virginia. Trilogy Federal is an Equal Employment Opportunity employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.