Peraton
Medicaid Fraud Auditor
Peraton, Herndon, Virginia, United States, 22070
Medicaid Fraud AuditorJob Locations:
USRequisition ID
2024-149801
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
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 advanced knowledge to solve a variety of business issues, works on problems with moderate to large complex scopes, and provides analysis of information while exercising independent judgment within defined practices and procedures.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 as part of a team, providing ongoing progress reports and updates on audit status;Presents issues of concern, verified through data, citing regulatory violations, and proving schemes or scams to defraud the Government;Composes correspondence, reports, and referral summary letters;Ensures that projects are timely, complete, and accurate;Actively participates in meetings and attends training to further 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 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. As the world's leading mission capability integrator and transformative enterprise IT provider, we deliver trusted 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
2024-149801
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
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 advanced knowledge to solve a variety of business issues, works on problems with moderate to large complex scopes, and provides analysis of information while exercising independent judgment within defined practices and procedures.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 as part of a team, providing ongoing progress reports and updates on audit status;Presents issues of concern, verified through data, citing regulatory violations, and proving schemes or scams to defraud the Government;Composes correspondence, reports, and referral summary letters;Ensures that projects are timely, complete, and accurate;Actively participates in meetings and attends training to further 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 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. As the world's leading mission capability integrator and transformative enterprise IT provider, we deliver trusted 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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