Peraton
Fraud Investigator (Medicaid/Medicare)
Peraton, Reston, Virginia, United States, 22090
Fraud Investigator (Medicaid/Medicare)Job Locations:
USRequisition ID
2024-149803
Position Category
Business Controls
Clearance
No Clearance Required
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.The
Fraud Investigator
is expected to perform high level complex investigations of medical professional service providers and develop cases for future action, including referral to law enforcement, education, overpayment recovery, and other administrative actions. Will work with internal resources and external agencies to develop cases and corrective actions as well as respond to requests for data and support.An investigator uses good judgment and may work independently with minimum supervision and direction.The investigator may also work as part of a team with state and/or federal investigators and other personnel.An investigator handles multiple caseload assignments concurrently; organizes and analyzes complex evidentiary patterns; interviews and obtains statements from witnesses and others.Investigators may also be required to complete complex investigative reports that apply regulations or rules to the program(s) affected by the behavior being investigated.Investigators are expected to research and understand the relevant offenses being investigated; conduct efficient and effective investigations concerning those alleged offenses and detect or verify suspected violations.Investigators analyze the results of the investigation to ascertain if the allegations have been corroborated and work with others to determine appropriate steps to address the issues.As part of an investigation, the investigator will need to prepare correspondence; be objective and accurate and communicate with others with tact.Investigators maintain confidentiality and understand all the laws, rules, and regulations concerning health privacy.Telework available from:
Maine, New Hampshire, Vermont, New York, Rhode Island, Connecticut, Massachusetts, Pennsylvania, Delaware, District of Columbia, New Jersey, Maryland, Northern Virginia.Qualifications
Basic Qualifications:
2 years with BS/BA; 0 years with MS/MA; 6 years with High School diploma.2 years investigative experience.Knowledge of Medicare and/or Medicaid programs and the rules, regulations, policies, and procedures.Knowledge and experience in the healthcare industry.Strong investigative skills.Strong communication and organization skills.Strong PC knowledge and skills.US citizenship is required.Preferred Qualifications:
Strong background in investigations.Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases.Knowledge of investigative practices regarding healthcare providers.Background in evaluating, reviewing, and analyzing medical claims and records.Ability to learn and operate a variety of data systems, equipment, and tools used in investigations.Essential Functions:
Ability to perform research and draw conclusions.Ability to organize a case file, accurately and thoroughly document all steps taken.Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government.Ability to compose correspondence, reports, and referral summary letters.Ability to communicate effectively, internally and externally.Ability to interpret laws and regulations.Ability to handle confidential material.Ability to manage and prioritize workload effectively.Ability to educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters.Ability to work independently and as a member of a team to deliver high quality work.This position may require the incumbent to appear in court to testify about work findings.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.Target Salary Range
$51,000 - $82,000. This represents the typical salary range for this position based on experience and other factors.
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USRequisition ID
2024-149803
Position Category
Business Controls
Clearance
No Clearance Required
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.The
Fraud Investigator
is expected to perform high level complex investigations of medical professional service providers and develop cases for future action, including referral to law enforcement, education, overpayment recovery, and other administrative actions. Will work with internal resources and external agencies to develop cases and corrective actions as well as respond to requests for data and support.An investigator uses good judgment and may work independently with minimum supervision and direction.The investigator may also work as part of a team with state and/or federal investigators and other personnel.An investigator handles multiple caseload assignments concurrently; organizes and analyzes complex evidentiary patterns; interviews and obtains statements from witnesses and others.Investigators may also be required to complete complex investigative reports that apply regulations or rules to the program(s) affected by the behavior being investigated.Investigators are expected to research and understand the relevant offenses being investigated; conduct efficient and effective investigations concerning those alleged offenses and detect or verify suspected violations.Investigators analyze the results of the investigation to ascertain if the allegations have been corroborated and work with others to determine appropriate steps to address the issues.As part of an investigation, the investigator will need to prepare correspondence; be objective and accurate and communicate with others with tact.Investigators maintain confidentiality and understand all the laws, rules, and regulations concerning health privacy.Telework available from:
Maine, New Hampshire, Vermont, New York, Rhode Island, Connecticut, Massachusetts, Pennsylvania, Delaware, District of Columbia, New Jersey, Maryland, Northern Virginia.Qualifications
Basic Qualifications:
2 years with BS/BA; 0 years with MS/MA; 6 years with High School diploma.2 years investigative experience.Knowledge of Medicare and/or Medicaid programs and the rules, regulations, policies, and procedures.Knowledge and experience in the healthcare industry.Strong investigative skills.Strong communication and organization skills.Strong PC knowledge and skills.US citizenship is required.Preferred Qualifications:
Strong background in investigations.Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases.Knowledge of investigative practices regarding healthcare providers.Background in evaluating, reviewing, and analyzing medical claims and records.Ability to learn and operate a variety of data systems, equipment, and tools used in investigations.Essential Functions:
Ability to perform research and draw conclusions.Ability to organize a case file, accurately and thoroughly document all steps taken.Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government.Ability to compose correspondence, reports, and referral summary letters.Ability to communicate effectively, internally and externally.Ability to interpret laws and regulations.Ability to handle confidential material.Ability to manage and prioritize workload effectively.Ability to educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters.Ability to work independently and as a member of a team to deliver high quality work.This position may require the incumbent to appear in court to testify about work findings.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.Target Salary Range
$51,000 - $82,000. This represents the typical salary range for this position based on experience and other factors.
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