Medicaid Fraud Auditor
Job Description
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.
What you’ll do:
This Fraud Auditor will conduct audits and reviews of various Medicaid programs to ensure compliance with federal and state program requirements and to recover over-payments for non-compliance. The individual applies 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 limited project direction input. Exercises independent judgment within defined practices and procedures to determine appropriate action. Follows established guidelines and correctly interprets policies. Evaluates unique circumstances and makes recommendations.
- Provides research, interpret 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.
- Handle 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, 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.
- Ensures that projects are timely, complete and accurate.
- Actively participants at meetings and attends training to further his business acumen.
- This is a remote position, candidates must reside within the North East Jurisdiction which include 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:
- 2 years with BS/BA; 0 years with MS/MA; 6 years with no degree
- 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
Preferred Qualifications:
- 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
Target Salary Range
$51,000 – $82,000. This represents the typical salary range for this position based on experience and other factors.
SCA / Union / Intern Rate or Range
EEO
An Equal Opportunity Employer including Disability/Veteran.
Our Values
Benefits
At Peraton, our benefits are designed to help keep you at your best beyond the work you do with us daily. We’re fully committed to the growth of our employees. From fully comprehensive medical plans to tuition reimbursement, tuition assistance, and fertility treatment, we are there to support you all the way.
- Paid Time-Off and Holidays
- Retirement
- Life & Disability Insurance
- Career Development
- Tuition Assistance and Student Loan Financing
- Paid Parental Leave
- Additional Benefits
- Medical, Dental, & Vision Care