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:

The Fraud Investigator 's primary responsibilities include being a point of contact for the Center for Medicare and Medicaid Services (CMS) and/or Medicare Administrative Contractors (MAC) regarding administrative actions related to investigations.

• 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

Qualifications

Required Qualifications:

• 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 Qualifications:

• Medicare claim experience highly preferred
• Microsoft tools, i.e excel, word

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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