Administrative Action Lead – Medicare Investigations (Remote)

Peraton; Northern (KY); Hybrid; USD 66,000 - 106,000; Full time

Benefits offered by this job

Telework from East Coast

Job summary

Peraton is seeking an Administrative Action Lead to guide the SGS team in analysis, investigation, and review for action development. You will mentor staff, coordinate with CMS, and ensure timely completion of actions while maintaining compliance with Medicare requirements.

The role emphasizes independent judgment within policy, workload oversight, and high-quality documentation, with telework available from East Coast.

Qualifications

• Minimum of 8 years with BS/BA or 12 years experience with a HS Diploma.
• 8 years of investigative experience required.
• Knowledge of Medicare requirements, laws, rules and regulations related to payment of services billed to the Program.
• Medicare claims processing knowledge.
• Strong communication and organization skills.
• US citizenship required.
• Desirable: CFE or AHFI certification.

Responsibilities

• Act as a point of contact for manager and coordinate with CMS on admin actions.
• Oversee workload and develop/admin action plans, ensuring timely resolution of investigations.
• Mentor team members and provide guidance to investigators on action development.
• Review workloads, conduct QC, and ensure timeliness and quality across actions.
• Monitor quality metrics (WMM/UCM) and escalate issues to management as needed.
• Participate in meetings and CMS high-priority projects; provide team direction.
• Develop efficient workflows and assess process effectiveness.
• Note: Telework available from East Coast.

Skills

Strong communication

US citizenship

Organizational skills

Computer literacy

Education

BS/BA or 12 years experience with HS Diploma

Tools

WMM

CMS

Claims review software

Job description

Peraton is seeking an Administrative Action Lead to guide the SGS team in analysis, investigation, and review for action development. You will mentor staff, coordinate with CMS, and ensure timely completion of actions while maintaining compliance with Medicare requirements.

The role emphasizes independent judgment within policy, workload oversight, and high-quality documentation, with telework available from East Coast.