Peraton ยท 4 hours ago
Fraud Investigator
United States
Full-time
Remote
Entry, Mid Level
$51K/yr - $82K/yr
2+ years exp
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No H1B
U.S. Citizen Only
Insider Connection @Peraton
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Responsibilities
Reviewing evidence supporting an administrative action by working with the Investigative Teams to ensure that the documentation gathered is sufficient to support an administrative action.
Admin actions could include, but not limited to revocations, payment suspensions, deactivations, overpayments, auto-denial edits, provider victim packages, prepayment edits, NSC referrals.
Preparing and submitting administrative action packages to CMS and the MACs for approval and processing and being able to speak to the actions development.
Telework available in the eastern time-zone.
Qualification
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Required
Bachelors degree with 2 years experience; Masters degree 0 years or High School with 6 years experience
Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed to the Program, familiar with Medicare claim types, interpreting medical review results
Strong communication and organization skills
Experience in analysing claim information and the MACs systems
Strong PC knowledge and skills
Assist team members when called upon.
Monitor the progress of the administrative action to ensure all timelines are met.
Ability to perform research and draw conclusions
Ability to present issues of concern, citing regulatory violations
Ability to organize a case file, accurately and thoroughly document all steps taken
Ability to compose correspondence, reports and outgoing letters to CMS, providers and MACs
Ability to communicate effectively, internally and externally
Ability to interpret laws and regulations
Ability to handle confidential material
Ability to report work activity on a timely basis
Ability to work independently and as a member of a team to deliver high quality work
Ability to attend meetings, training, and conferences, overnight travel may be required
US Citizenship is Required
Preferred
Medicare claim experience highly preferred
Microsoft tools, i.e excel, word
Benefits
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
Company
Peraton
Peraton Fearlessly solving the toughest national security challenges.
10,001+ employees
Funding
Current Stage
Late StageLeadership Team
Thomas Terjesen
Chief Information Officer
Recent News
2024-04-18
2024-04-01
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