Peraton
Medicaid Fraud Auditor
Peraton, Reston, Virginia, United States, 22090
Medicaid Fraud AuditorJob Locations: USRequisition ID:
2024-149801Position Category:
Business ControlsClearance:
No Clearance RequiredResponsibilities
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
Medicaid Fraud Auditor
will conduct audits and reviews of various Medicaid programs to ensure compliance with federal and state program requirements and to identify exceptions of non-compliance that may result in the recovery of over-payments. The individual applies advance level of subject matter knowledge to solve a variety of common business issues. Works on problems with moderate to large complex scopes. Acts as an informed team member providing analysis of information and limited project direction input. Exercises independent judgment within defined practices and procedures to determine appropriate action. Follows established guidelines and correctly interprets rules, regulations, and other guidance. Evaluates unique circumstances, prepares analytical reviews, identifies exceptions, prepares reports, and makes recommendations for corrective action.What you'll do:Provides research, interprets laws and regulations, performs data analysis, and draws conclusions for projects;Conducts compliance audits of varied Medicaid case-types, audits claim submissions, and performs ad-hoc focused audits;Handles several 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, and improper payments;Organizes a case file, accurately and thoroughly documents all steps taken;Works independently or at times as part of a team, providing 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;Composes correspondence, reports, and referral summary letters;Works under general supervision and as a member of a team to deliver high-quality work;Ensures that projects are timely, complete, and accurate;Actively participates 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, District of Columbia, and Virginia.Qualifications
Basic Qualifications:Bachelor's degree from an accredited college or university.Minimum of 2 years professional work experience in business, healthcare, law enforcement, health science, or a related field.Knowledge of internal audit/investigative policies and operating principles.Understanding of Medicare/Medicaid or healthcare auditing.Understanding of Medicaid Managed Care Plans preferred.Research and analytical skills.Strong familiarity with Microsoft Office tools, including intermediate to advanced knowledge of Excel.US Citizenship is required.The most competitive candidates will have:Intermediate financial and business acumen.Intermediate audit/investigative skills.Project management skills.Knowledge of the healthcare industry and medical coding concepts and/or experience analyzing health care claims data is preferred.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.
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2024-149801Position Category:
Business ControlsClearance:
No Clearance RequiredResponsibilities
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
Medicaid Fraud Auditor
will conduct audits and reviews of various Medicaid programs to ensure compliance with federal and state program requirements and to identify exceptions of non-compliance that may result in the recovery of over-payments. The individual applies advance level of subject matter knowledge to solve a variety of common business issues. Works on problems with moderate to large complex scopes. Acts as an informed team member providing analysis of information and limited project direction input. Exercises independent judgment within defined practices and procedures to determine appropriate action. Follows established guidelines and correctly interprets rules, regulations, and other guidance. Evaluates unique circumstances, prepares analytical reviews, identifies exceptions, prepares reports, and makes recommendations for corrective action.What you'll do:Provides research, interprets laws and regulations, performs data analysis, and draws conclusions for projects;Conducts compliance audits of varied Medicaid case-types, audits claim submissions, and performs ad-hoc focused audits;Handles several 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, and improper payments;Organizes a case file, accurately and thoroughly documents all steps taken;Works independently or at times as part of a team, providing 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;Composes correspondence, reports, and referral summary letters;Works under general supervision and as a member of a team to deliver high-quality work;Ensures that projects are timely, complete, and accurate;Actively participates 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, District of Columbia, and Virginia.Qualifications
Basic Qualifications:Bachelor's degree from an accredited college or university.Minimum of 2 years professional work experience in business, healthcare, law enforcement, health science, or a related field.Knowledge of internal audit/investigative policies and operating principles.Understanding of Medicare/Medicaid or healthcare auditing.Understanding of Medicaid Managed Care Plans preferred.Research and analytical skills.Strong familiarity with Microsoft Office tools, including intermediate to advanced knowledge of Excel.US Citizenship is required.The most competitive candidates will have:Intermediate financial and business acumen.Intermediate audit/investigative skills.Project management skills.Knowledge of the healthcare industry and medical coding concepts and/or experience analyzing health care claims data is preferred.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.
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