Medicaid Fraud Auditor - job 1 of 2

Responsibilities

SafeGuard 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 Medicaid Fraud Auditor to our SGS team of talented professionals.

 

What you'll do:

 

This individual will conduct high level complex audits and reviews of medical professional service providers to ensure compliance with federal and state program requirements and if determined, recommend recovery of over-payments for non-compliance. The individual applies an intermediate level of subject matter knowledge to solve a variety of common business issues. Works on problems of moderately complex scope. Acts as an informed team member providing analysis of information and project direction input. Exercises independent judgment within defined practices and procedures to determine appropriate action. Follows established guidelines and correctly interpret policies. Evaluates unique circumstances and makes recommendations. Specifically, 

• Provides research, interprets laws and regulations, performs data analysis and draws conclusions for projects.
• Uses good judgment conducting compliance audits of varied Medicaid case-types, auditing claim submissions and performing ad-hoc focused audits.
• Handles multiple assignments concurrently; organizes and analyzes billing patterns; conducts interviews and obtains statements from beneficiaries/recipients and others.
• Develops an understanding of the function to be audited and uses business knowledge, analytical skills, and experience in identifying findings and making recommendations for improvements.
• Identifies compliance exceptions, conflicts of interest, improper payments.
• Organizes a case file, accurately and thoroughly documents all steps taken.
• Works independently or at times as part of a team, provide ongoing progress reports and updates on audit status.
• Presents issues of concern verified through data, citing regulatory violations, proving schemes or scams to defraud the Government.
• Compose correspondence, reports, and referral summary letters.
• Works under general supervision and as a member of a team to deliver high quality work.
• Ensure that projects are timely, complete and accurate; and,
• Actively participants at meetings and attends training to further his business acumen.
• This is a remote position, candidates must reside within the Northeast Jurisdiction which includes the states of Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, Pennsylvania, New Jersey, Delaware, Maryland, and District of Columbia.

Qualifications

Basic Qualifications:

• 4 years with an Associate's degree; 2 years with a Bachelor’s degree; or High School diploma with 6 years experience in lieu of a degree.
• Degree in finance, accounting or a health-related field preferred.
• Knowledge of internal audit/investigative policies and operating principles.
• Understanding Medicare/Medicaid or healthcare auditing.
• Strong research, analytical, interpersonal skills.
• Strong familiarity with Microsoft Office tools, including intermediate to advanced knowledge of Excel and pivot tables.
• U.S. citizenship is required.

The most competitive candidates will have:

• Financial and business acumen.
• Intermediate audit/investigative skills.
• Project management skills.
• Knowledge of the healthcare industry, medical coding concepts and/or experience analyzing health care claims data.

 

Peraton Overview

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 peraton.com to learn how we’re keeping people around the world safe and secure.

Target Salary Range

$51,000 - $82,000. This represents the typical salary range for this position based on experience and other factors.

EEO

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