Fraud Investigator Admin Action

Fraud Investigator Admin Action

Job Location s: US

Requisition :

Position Category:
Business Controls

Clearance:
No Clearance Required

Safe Guard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.

We are looking to add a Fraud Investigator Admin Action Specialist to our SGS team of talented professionals.

The Fraud Investigator Admin Action Specialist is responsible for being a Point of Contact for Investigations, MAC and CMS regarding all administrative actions related to investigations.

• Review and verify evidence supporting an administrative action as it relates to payment suspensions, revocations, over payments as well as other administrative actions that can be pursued.
• Work with the Investigations, Medical Review and Data teams to ensure that the documentation gathered is sufficient to support an administrative action.
• Making administrative action recommendation to Investigations and CMS.
• Work with CMS, law enforcement and the Medicare Administrative Contractor throughout the life of the action.
• Monitor workload to ensure all actions are taken within the required time frames set forth in the Program Integrity Manual.
• Prepare and submit administrative action packages to CMS and the MACs for approval and processing and speak to the action development.
• Ensure that all timelines are followed.
• Telework available from any location but must be available during eastern time zone hours.

Basic Qualifications:

• 4 years with AS/AA; 2 years with BS/BA; 0 years with MS/MA; 6 years with High School diploma/equivalent in lieu degree
• Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed to the Program
• Strong critical thinking, communication, writing and organizational skills
• Experience in developing fraud cases
• Strong PC knowledge and skills
• Knowledge of Medicare systems
• Ability to perform research and draw conclusions
• Ability to present issues of concern, citing and interpreting regulatory violations
• Ability to organize a case file, accurately and thoroughly document all steps taken
• Ability to compose correspondence, reports and letters clearly and concisely.
• Ability to communicate effectively, internally and externally
• Ability to interpret laws and regulations
• Ability to handle confidential material
• Ability to report work activity on a timely basis
• Ability to work independently and as a member of a team to deliver high quality work
• Ability to attend meetings, training, and conferences, overnight travel may be required
• US citizenship required

Desirable

Qualifications:

• The most competitive candidates will have:
  Medicare fraud investigation and/or Medicare billing background
• Investigation
• CFE or AHFI certification

Peraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world s leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace.

The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees do the can t be done by solving the most daunting challenges facing our customers. Visit  to learn how we re keeping people around the world safe and secure.

$51,000 - $82,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual s experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.

EEO:
Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.